WorldWideScience

Sample records for banded sleeve gastrectomy

  1. Laparoscopic Sleeve Gastrectomy versus Laparoscopic Banded Sleeve Gastrectomy: First Prospective Pilot Randomized Study

    Directory of Open Access Journals (Sweden)

    Valeria Tognoni

    2016-01-01

    Full Text Available Introduction. The placement of ring or band around the gastric tube might prevent the dilation after Laparoscopic Sleeve Gastrectomy (LSG. We describe the first randomized study comparing LSG and Laparoscopic Banded Sleeve Gastrectomy (LBSG. Material and Method. Fifty obese patients were enrolled in the study between January 2014 and January 2015. We analysed differences in operative time, complication rate, mortality, and BMI between the two groups over a period of 12 months. Results. Twenty-five patients received LSG (group A and 25 LBSG (group B. The mean preoperative BMI was 47.3±6.58 kg/m2 and 44.95±5.85 kg/m2, respectively, in the two groups. There was no statistical relevant difference in operative time. No intraoperative complications occurred. Mean BMI registered after 3, 6, and 12 months in groups A and B, respectively, were 37.86±5.72 kg/m2 and 37.58±6.21 kg/m2 (p=0.869, 33.64±6.08 kg/m2 and 32.03±5.24 kg/m2 (p=0.325, and 29.72±4.40 kg/m2 and 27.42±4.47 kg/m2 (p=0.186; no statistical relevant difference was registered between the two groups. Conclusion. LBSG is a safe and feasible procedure. The time required for the device positioning did not influence significantly the surgical time. The results of bodyweight loss did not document any statistically significant differences among the two groups, even though LBSG group showed a mean BMI slightly lower than that of the control group.

  2. Changes in Gut Hormones After Roux en Y Gastric bypass, Sleeve Gastrectomy, and Adjustable Gastric Banding

    Directory of Open Access Journals (Sweden)

    Miroslav Ilić

    2015-12-01

    Full Text Available The obesity epidemic has burdened healthcare systems worldwide. Bariatric surgery is currently the most effective method for long-term weight loss in obese adults, but the exact mechanism of weight loss is poorly understood. Bariatric procedures were initially classified by their presumed mechanism of action into restrictive, malabsoptive, or mixed procedures; however, due to recent advancements in the field of neuroendocrinology, hormones are increasing being recognized as important regulators of satiation, hunger, and energy expenditure. Studies examining changes in gut hormones following bariatric surgery have yielded conflicting results and the relationship between these hormones and weight loss is nothing but clear. This review will summarize the effect of Roux en Y gastric bypass, sleeve gastrectomy and adjustable gastric banding on various gut hormones including ghrelin, cholecystokinin, glucagon-like polypeptide-1, peptide YY3, and pancreatic polypeptide. Furthermore, the relationship between these hormones and weight loss will be examined.

  3. Comparison of percentage excess weight loss after laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding

    Science.gov (United States)

    Bobowicz, Maciej; Lech, Paweł; Orłowski, Michał; Siczewski, Wiaczesław; Pawlak, Maciej; Świetlik, Dariusz; Witzling, Mieczysław; Michalik, Maciej

    2014-01-01

    Introduction Laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) are acceptable options for primary bariatric procedures in patients with body mass index (BMI) 35–55 kg/m2. Aim The aim of this study is to compare the effects of these two bariatric procedures 6, 12 and 24 months after surgery. Material and methods Two hundred and two patients were included 72 LSG and 130 LAGB patients. The average age was 38.8 ±11.9 and 39.4 ±10.4 years in LSG and LAGB groups, with initial BMI of 44.1 kg/m2 and 45.2 kg/m2, p = NS. Results The mean percentage of excess weight loss (%EWL) at 6 months for LSG vs. LAGB was 36.3% vs. 30.1% (p = 0.01) and at 12 months was 43.8% vs. 34.6% (p = 0.005). The greatest difference in the mean %EWL at 12 months was observed in patients with initial BMI of 40–49.9 kg/m2 in favor of LSG (47.5% vs. 35.6%; p = 0.01). Two years after surgery there was no advantage of LSG and in the subgroup of patients with BMI 50–55 kg/m2 there was a trend in favor of LAGB (57.2% vs. 30%; p = 0.07). The multiple regression model of independent variables (age, gender, initial BMI and the presence of comorbidities) proved insignificant in prediction of the best outcome in means of %EWL for either operative modality. None of these factors in the logistic regression model could determine the type of surgery that should be used in particular patients. Conclusions During the first 2 years after surgery, the best results were obtained in women with lower BMI undergoing LSG surgery. The LSG provides greater %EWL after a shorter period of time though the difference decreases in time. PMID:25337157

  4. Laparoscopic sleeve gastrectomy after failed gastric banding: is it really effective? Six years of follow-up.

    Science.gov (United States)

    Carandina, Sergio; Genser, Laurent; Bossi, Manuela; Polliand, Claude; Tabbara, Malek; Barrat, Christophe

    2017-07-01

    Laparoscopic sleeve gastrectomy (LSG) has become a valuable surgical option to rescue laparoscopic adjustable gastric banding (LAGB) failures. The aim of this study was to determine whether conversion to LSG after failed LAGB (CLSG) is a well-tolerated and effective rescue procedure compared with primary LSG (PLSG) in the long term. University hospital, France. A retrospective review of data concerning consecutive patients receiving a LSG between February 2008 and December 2014 was conducted. Mortality, postoperative complications, and weight loss outcomes were analyzed. Of 701 LSG, 601 (85.7%) were PLSG and 100 (14.3%) were CLSG. The mortality rate was 0%. Overall morbidity was comparable between the primary and conversion group (10% versus 6%, P = .27). The mean percentage of excess weight loss at 3, 36, and 72 months was 34.9%, 72.1%, and 57.2% after PLSG and 22.6%, 51.2% and 29.8% after CLSG (P<.05). The failure rate (mean percentage of excess weight loss<50%) was higher in the CLSG group during the first 5 postoperative years (P < .001) with more than two thirds of the CLSG considered as having failed at 60 months. Patients who underwent band ablation as a result of insufficient weight loss or weight regain presented the worst results after conversion to LSG. In this study, the conversion of failed LAGB to LSG in 2 steps indicated a safety profile comparable to that of primary LSG but was significantly less effective from the early postoperative course (3 mo) up to 6 years postoperatively. CLSG may not be the best option because a third operation may be needed as a result of insufficient weight loss. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  5. The influence of laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy on weight loss, plasma ghrelin, insulin, glucose and lipids

    Directory of Open Access Journals (Sweden)

    Hady Razak Hady

    2012-07-01

    Full Text Available The aim of this study was to assess the impact of laparoscopic gastric banding and laparoscopic sleeve gastrectomy on the concentration of ghrelin, insulin, glucose, triglycerides, total and HDL-cholesterol, as well as AST and ALT levels in plasma in patients with obesity. The research includes 200 patients operated using LAGB (34 men average age 37.0 ± 12.6 years and 66 women average age 39.18 ± 12.17 years and LSG (48 men average age 47.93 ± 9.24 years and 52 women, 19 ± 9.33 years. The percentage of effective weight loss, effective BMI loss, concentration of ghrelin, insulin, glucose, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, ALT, AST and HOMA IR values was taken preoperatively and at 7th day, 1 month, 3 and 6 months after surgery. Both after LSG and after LAGB, statistically significant reduction in BMI, serum insulin, glucose and HOMA IR was noticed in comparison to the preoperative values. Post LAGB, patients showed an increase of ghrelin, while LSG proved ghrelin decreased. Correlations between glucose and BMI loss, and between insulin and BMI loss in both cases are more favorable in the LSG group. Lipid parameters, AST and ALT have undergone declines or  increases in the particular time points. Both techniques cause weight loss and this way lead to changes in the concentration of ghrelin, as well as to the improvement of insulin, glucose, cholesterol and triglycerides metabolism. They reduce metabolic syndrome and multiple comorbidities of obesity.

  6. Weight Loss after Sleeve Gastrectomy in Super Superobesity

    Directory of Open Access Journals (Sweden)

    J.-M. Catheline

    2012-01-01

    Full Text Available Objective. This prospective study evaluated laparoscopic sleeve gastrectomy for its safety and efficiency in excess weight loss (%EWL in super superobese patients (BMI >60 Kg/m2. Results. Thirty patients (33 women and 7 men were included, with mean age of 35 years (range 18 to 59. Mean preoperative BMI was 66 Kg/m2 (range 60 to 85. The study included one patient with complete situs inversus and 4 (14% with previous restrictive gastric banding. The mean operative time was 120 minutes (range 80 to 220 min and the mean hospital stay was 7.5 days (4 to 28 days. There was no postoperative mortality or need for a laparotomy conversion. Two subphrenic hematomas, one gastric fistula, and one pulmonary embolism, were the major complications. After 18 months 17 (77% had sufficient weight loss and six had insufficient results, leading to either re-sleeve gastrectomy (3, or gastric bypass (2. Three years after the initial laparoscopic sleeve gastrectomy, the mean EWL was 51% (range 21 to 82. Conclusion. The laparoscopic sleeve gastrectomy is a safe and efficient operating procedure for treating super superobesity. In the case of insufficient weight loss, a second-stage operation like resleeve gastrectomy or gastric bypass can be proposed.

  7. Gastroesophageal Reflux Disease and Sleeve Gastrectomy.

    Science.gov (United States)

    Melissas, John; Braghetto, Italo; Molina, Juan Carlos; Silecchia, Gianfranco; Iossa, Angelo; Iannelli, Antonio; Foletto, Mirto

    2015-12-01

    Gastroesophageal reflux disease (GERD) and/or hiatus hernia (HH) are one of the most common disorders of the upper gastrointestinal tract. Despite the positive effect of sleeve gastrectomy (SG) regarding weight loss and improvement in obesity co-morbidities, there are concerns about the development of de novo gastroesophageal reflux disease or worsening the existing GERD after this bariatric operation. Furthermore, controversy exists on the consequences of SG in lower esophageal sphincter function and about the ideal procedure when a hiatus hernia is preoperatively diagnosed or discovered during the laparoscopic SG. This review systematically investigates the incidence, the pathophysiology of GERD and/or HH in morbidly obese individuals before and after SG, and the treatment options for concomitant HH repair during laparoscopic sleeve gastrectomy.

  8. Gastritis in patients undergoing sleeve gastrectomy

    Science.gov (United States)

    Rath-Wolfson, Lea; Varona, Roy; Bubis, Golan; Tatarov, Alexander; Koren, Rumelia; Ram, Edward

    2017-01-01

    Abstract Laparoscopic sleeve gastrectomy (LSG) is a therapeutic option in severely obese patients. The aim of this study was to evaluate the presence of Helicobacter pylori (HP) gastritis and non-Helicobacter gastritis in the gastrectomy specimens, and its association to other variables. One hundred six sleeve gastrectomy specimens were examined histopathologically for the presence of gastritis and its relation to other factors like ethnicity, glycemic control, and postoperative complications. Twelve patients had HP gastritis, 39 had non-HP gastritis, and 55 had normal mucosa. There was a statistical difference between the Arab and Jewish Israeli patients in our study. Twenty-eight of the Arab patients had HP gastritis and 48% had non-HP gastritis. In the Jewish population 6% had HP gastritis and 34% had non-HP gastritis. The preoperative glycemic control was worse in the gastritis group with a mean HbA1c of 8.344% while in the normal mucosa group the mean HbA1c was 6.55. After operation the glycemic control reverted to normal in most the diabetic patients. There were few postoperative complications however, they were not related to HP. There is a high incidence of gastritis in obese patients. The incidence of gastritis in the Arab population in our study was higher than that in the Jewish population. The glycemic control before surgery was worse in patients with gastritis than in the normal mucosa group. HP bares no risk for postoperative complications after LSG and does not affect weight loss. However a larger cohort of patients must be studied to arrive at conclusive results. PMID:28422853

  9. What matters after sleeve gastrectomy: patient characteristics or surgical technique?

    Science.gov (United States)

    Dhar, Vikrom K; Hanseman, Dennis J; Watkins, Brad M; Paquette, Ian M; Shah, Shimul A; Thompson, Jonathan R

    2018-03-01

    The impact of operative technique on outcomes in laparoscopic sleeve gastrectomy has been explored previously; however, the relative importance of patient characteristics remains unknown. Our aim was to characterize national variability in operative technique for laparoscopic sleeve gastrectomy and determine whether patient-specific factors are more critical to predicting outcomes. We queried the database of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program for laparoscopic sleeve gastrostomies performed in 2015 (n = 88,845). Logistic regression models were used to determine predictors of postoperative outcomes. In 2015, >460 variations of laparoscopic sleeve gastrectomy were performed based on combinations of bougie size, distance from the pylorus, use of staple line reinforcement, and oversewing of the staple line. Despite such substantial variability, technique variants were not predictive of outcomes, including perioperative morbidity, leak, or bleeding (all P ≥ .05). Instead, preoperative patient characteristics were found to be more predictive of these outcomes after laparoscopic sleeve gastrectomy. Only history of gastroesophageal disease (odds ratio 1.44, 95% confidence interval 1.08-1.91, P < .01) was associated with leak. Considerable variability exists in technique among surgeons nationally, but patient characteristics are more predictive of adverse outcomes after laparoscopic sleeve gastrectomy. Bundled payments and reimbursement policies should account for patient-specific factors in addition to current accreditation and volume thresholds when deciding risk-adjustment strategies. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. [Perioperative managment of laparoscopic sleeve gastrectomy].

    Science.gov (United States)

    Chang, Xu-sheng; Yin, Kai; Wang, Xin; Zhuo, Guang-zuan; Ding, Dan; Guo, Xiang; Zheng, Cheng-zhu

    2013-10-01

    To summarize the surgical technique and perioperative management of laparoscopic sleeve gastrectomy (LSG). A total of 57 morbid obesity patients undergoing LSG surgery from May 2010 to December 2012 were enrolled in the study, whose clinical data in perioperative period were analyzed retrospectively. These patients had more than 1 year of follow-up. All the patients received preoperative preparation and postoperative management, and postoperative excess weight loss(EWL%) and improvement of preoperative complications was evaluated. All the cases completed the operation under laparoscopy, except 1 case because of the abdominal extensive adhesion. The average operation time was(102.0±15.2) min and the mean intraoperative blood loss (132.3±45.6) ml. Of 2 postoperative hemorrhage patients, 1 case received conservative treatment, and another one underwent laparoscopic exploration. The EWL% at 3 months, 6 months and 1 year after procedure was (54.9±13.8)%, (79.0±23.6)% and (106.9±25.1)% respectively. The preoperative complications were improved in some degree. There were no operative death, and anastomotic leak, anastomotic stenosis, or surgical site infection occurred. LSG is a safe and effective surgical technique, whose safety and efficacy may be increased by improving the perioperative management.

  11. Rare Neurological Complications After Sleeve Gastrectomy.

    Science.gov (United States)

    Tabbara, Malek; Carandina, Sergio; Bossi, Manuela; Polliand, Claude; Genser, Laurent; Barrat, Christophe

    2016-12-01

    Bariatric surgery is considered to be the most effective treatment of morbid obesity and improvement of obesity-related comorbidities, such as type II diabetes. However, both peripheral and central neurological complications can occur after bariatric surgery. Such complications tend to occur more frequently after bypass surgery than after sleeve gastrectomy (SG). The objective of this study was to identify the patients that presented post-operative neurological complications after undergoing SG and describe the incidence, presentation, and management of these complications. This was a retrospective study of 592 cases of SG performed between 2009 and 2014 with a special focus on patients who presented neurological complications. Of the 592 SG cases, only seven (1.18 %) patients presented neurological complications. All patients had uneventful post-operative course, but all reported feeding difficulties, accompanied by severe dysphagia, and rapid weight loss, with a mean weight loss of 35 kg (30-40 kg) 3 months after SG. All patients were readmitted owing to neurological symptoms that included paresthesia, abolition of deep tendon reflexes of the lower limbs, muscle pain, and motor and sensitive deficits in some cases. There were two cases of Wernicke's encephalopathy. All patients were treated for neuropathy secondary to vitamin B1 deficiency and had a significant improvement and/or resolution of their symptoms. Neurological complications after SG are rare and are often preceded by gastrointestinal symptoms, rapid weight loss, and lack of post-operative vitamin supplementation. Re-hospitalization and multidisciplinary team management are crucial to establish the diagnosis and initiate treatment.

  12. Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Nguyen, Ninh T; Nguyen, Brian; Gebhart, Alana; Hohmann, Samuel

    2013-02-01

    Laparoscopic sleeve gastrectomy is gaining popularity in the US; however, there has been no study examining the use of sleeve gastrectomy at a national level and its impact on the use of other bariatric operations. The aim of this study was to examine contemporary changes in use and outcomes of bariatric surgery performed at academic medical centers. Using ICD-9 diagnosis and procedure codes, clinical data obtained from the University HealthSystem Consortium database for all bariatric procedures performed for the treatment of morbid obesity between October 1, 2008 and September 30, 2012 were reviewed. Quartile trends in use for the 3 most commonly performed bariatric operations were examined, and a comparison of perioperative outcomes between procedures was performed within a subset of patients with minor severity of illness. A total of 60,738 bariatric procedures were examined. In 2008, the makeup of bariatric surgery consisted primarily of gastric bypass (66.8% laparoscopic, 8.6% open), followed by laparoscopic gastric banding (23.8%). In 2012, there was a precipitous increase in use of laparoscopic sleeve gastrectomy (36.3 %), with a concurrent reduction in the use of laparoscopic (56.4%) and open (3.2%) gastric bypass, and a major reduction in laparoscopic gastric banding (4.1%). The length of hospital stay, in-hospital morbidity and mortality, and costs for laparoscopic sleeve gastrectomy were found to be between those of laparoscopic gastric banding and laparoscopic gastric bypass. Within the context of academic medical centers, there has been a recent change in the makeup of bariatric surgery. There has been an increase in the use of laparoscopic sleeve gastrectomy, which has had an impact primarily on reducing the use of laparoscopic adjustable gastric banding. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Association between postprandial symptoms and gastric emptying after sleeve gastrectomy

    NARCIS (Netherlands)

    Burgerhart, Jan S.; van Rutte, Pim W. J.; Edelbroek, Michela A. L.; Wyndaele, Dirk N. J.; Smulders, Johannes F.; van de Meeberg, Paul C.; Siersema, Peter D.; Smout, André J. P. M.

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure. However, postprandial symptoms can compromise its beneficial effect. It is not known if a changed gastric emptying and these symptoms are related. This study aimed to assess the association between postprandial symptoms and

  14. Laparoscopic Sleeve Gastrectomy Improves Olfaction Sensitivity in Morbidly Obese Patients.

    Science.gov (United States)

    Hancı, Deniz; Altun, Huseyin; Altun, Hasan; Batman, Burcin; Karip, Aziz Bora; Serin, Kursat Rahmi

    2016-03-01

    Olfactory abilities of the patients are known to be altered by eating and metabolic disorders, including obesity. There are only a number of studies investigating the effect of obesity on olfaction, and there is limited data on the changes in olfactory abilities of morbidly obese patients after surgical treatment. Here we investigated the changes in olfactory abilities of 54 morbidly obese patients (M/F, 22/32; age range 19-57 years; body mass index (BMI) range 30.5-63.0 kg/m(2)) after laparoscopic sleeve gastrectomy. A laparoscopic sleeve gastrectomy was performed by the same surgeon using five-port technique. Olfactory abilities were tested preoperatively and 1, 3, and 6 months after the surgery using a standardized Sniffin' Sticks Extended Test kit. Analyses of variance indicated statistically significant improvement in T, D, and I scores of morbidly obese patients within time factors (preoperative vs. 1, 3, and 6 months; 1 vs. 3 and 6 months; and 3 vs. 6 months; p < 0.001 for all). There was a statistically significant improvement in overall TDI scores with an increase from 25 to 41 during the 6 months follow-up period (p < 0.001 for all). Here, for the first time in literature, we were able to show the significant improvement in olfactory abilities of morbidly obese patients after laparoscopic sleeve gastrectomy.

  15. Esophageal adenocarcinoma five years after laparoscopic sleeve gastrectomy. A case report

    Directory of Open Access Journals (Sweden)

    Fernando Gabriel Wright

    2017-01-01

    Conclusion: We present a case of an esophageal adenocarcinoma five years after a laparoscopic sleeve gastrectomy for morbid obesity. There is need to better determine the relationship between sleeve gastrectomy and gastroesophageal reflux disease in order to prevent its related complications, such as esophageal adenocarcinoma.

  16. Dietary intake and ghrelin and leptin changes after sleeve gastrectomy

    OpenAIRE

    Bu?ga, Marek; Zavadilov?, Vladislava; Hol?czy, Pavol; ?vagera, Zden?k; ?vorc, Pavol; Foltys, Ale?; Zon?a, Pavel

    2014-01-01

    Introduction Surgical intervention in obesity is today the most effective treatment method in high level obesity management. Bariatric interventions not only ensure body weight reduction, but may influence dietary habits. Aim To assess changes in adipose hormones and dietary habits in obese patients after sleeve gastrectomy. Material and methods The study set comprised 37 subjects (29 females and 8 males) 24 to 68 years old with body mass index 43.0 ?4.9 kg/m2. Pre-operative examination inclu...

  17. Early Laparoscopic Sleeve Gastrectomy Outcomes in Terms of Weight Loss

    International Nuclear Information System (INIS)

    Siddiq, G.; Aziz, W.; Pervez, M. B.; Haider, M. I.; Hussain, S. V.; Khan, N.

    2016-01-01

    Objective: To investigate the outcomes of laparoscopic sleeve gastrectomy (LSG) in terms of weight loss. Study Design: Descriptive cohort study. Place and Duration of Study: Department of Surgery, Shifa International Hospital, Islamabad, from January 2009 to January 2015. Methodology: A total of 100 consecutive patients were included in the study through retrospective chart review. A 5-port technique was utilized with the gastric sleeve being created using endostapler. Postoperatively, patients gradually progressed from clear liquid diet and oral rehydration salts to nutritional supplements over three days. By two weeks postoperatively, patients had progressed to a solid diet. SPSS was used for data entry and analysis. Body mass index (BMI) and weight in kg were determined. Results: From 100 patients, 17 were lost to follow-up less than a week into the postoperative period. Of the remaining, average age of the patients was 34.7 ±11.3 years at the time of surgery. The majority of patients were females (72 percentage). Mean preoperative and postoperative BMI was 45.3 ±10.4 kg/m2 and 35.0 ±10 kg/m2, respectively. Of the 83 patients, 62 were followed-up for longer than 1 month (average 419 days). For patients in this category, mean reduction in BMI was 10.3 ±6.5 kg/m2 with average weight loss of 34.3 ±18.2 kg. There were no mortalities associated with LSG. Conclusion: Laparoscopic sleeve gastrectomy is a safe and effective intervention in young Pakistani females with encouraging outcomes at a mean follow-up of over one year. (author)

  18. Intra-thoracic Sleeve Migration (ITSM): an Underreported Phenomenon After Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Saber, Alan A; Shoar, Saeed; Khoursheed, Mousa

    2017-08-01

    Despite its technical simplicity, laparoscopic sleeve gastrectomy (LSG) complications are increasingly reported. Intra-thoracic sleeve migration (ITSM ) is a rare complication after LSG which has been inconsistently addressed in the literature. The purpose of this study was to emphasize ITSM occurrence after LSG and evaluate the perioperative factors associated with its development. Between January and July 2016, LSG patients diagnosed with ITSM at two bariatric surgery departments were identified. Perioperative factors were assessed for all the patients and compared between two groups, LSG alone and LSG with concomitant hiatal hernia (HH) repair (HHR). A total of 19 patients (6 males and 13 females) were included. Central obesity was present in 18 patients (94.7%). Nine patients (47.4%) had concomitant hiatal hernia repair during their original LSG. Post-LSG GERD (94.7%) (38.9% de novo and 61.1% recurrent) and post-LSG constipation (57.9%) were commonly associated with ITSM. Severe refractory GERD was the most common presentation for ITSM (94.7%), followed by epigastric pain (47.4%), persistent nausea/vomiting (36.8%), and dysphagia (21.1%). Time interval between primary LSG and ITSM diagnosis ranged from 1 day to 3 years. Patients with LSG and concomitant HHR presented with higher post-LSG BMI compared to the LSG patients (37 ± 6.4 kg/m 2 vs. 30.1 ± 6.3 kg/m 2 , p = 0.03). All the patients underwent successful reduction of ITSM and subsequent HHR. Central obesity, chronic constipation, post-LSG GERD, and concomitant HHR are commonly seen in post-laparoscopic sleeve gastrectomy intra-thoracic sleeve migration.

  19. Perioperative complications of sleeve gastrectomy: Review of the literature.

    Science.gov (United States)

    Iannelli, Antonio; Treacy, Patrick; Sebastianelli, Lionel; Schiavo, Luigi; Martini, Francesco

    2018-05-04

    Sleeve gastrectomy (SG) has known a spectacular rise worldwide during the last decade. The absence of digestive anastomosis simplifies the surgical technique, reducing anastomosis-related complications such as fistula, stricture and marginal ulcer. Furthermore, the respect for digestive continuity preserves the functions of pylorus, that regulates gastric emptying, and duodenum, where calcium, B vitamins and iron are absorbed. Despite the multiple advantages, SG also has specific complications such as bleeding, stenosis, portal thrombosis and leak. The staple line leak at the oesophagogastric junction is the most feared complication and its prevention remains difficult, as the involved mechanisms have been only partially elucidated. Its management is long and requires a multidisciplinary technical platform including Intensive Care Unit, digestive endoscopy and interventional radiology as well as a specialised surgeon. The aim of this review is to explain in detail the perioperative complications of SG, their prevention and treatment, referring to the most recent available literature.

  20. Pediatric laparoscopic sleeve gastrectomy in Turkey: Short-term results.

    Science.gov (United States)

    Ates, Ufuk; Ergun, Ergun; Gollu, Gulnur; Sozduyar, Sumeyye; Can, Ozlem Selvi; Yagmurlu, Aydin

    2018-05-01

    Obesity is one of the most rapidly increasing health problems in children. Laparoscopic sleeve gastrectomy (LSG) is one of the best treatment options and is feasible and safe in children. The aim of this study was to present the short-term results of a laparoscopic sleeve gastrectomy series in children. Children who underwent LSG in 2014-2017 were included in the study. Charts were investigated retrospectively and short-term weight loss was analyzed. Patients who had surgery in 2014-2017 were included in the study. There were six girls and two boys, and the median age was 15 years (range, 11-18 years). Mean weight was 159.25 ± 19.78 kg, and mean body mass index was 61.05 ± 8.5 kg/m 2 . Mean operation time was 70 min (range, 65-90 min), mean hospital stay was 5.1 days (range, 3-7 days), and mean follow up was 19.2 months (range, 1-43 months). Of these patients, five had hypertension and were under medication and two of these five also had hyperinsulinemia. One of the five children had Bardet-Biedl syndrome and one had bronchial asthma. After operation, medication was stopped in four of the eight children. At the time of writing, six patients were doing well without postoperative complications, or the need for reoperation. Even though the follow-up period was short and the number of patients was small, LSG was a feasible and promising surgical method for morbidly obese children. A multidisciplinary approach and lifelong behavior therapy are key steps for success. © 2018 Japan Pediatric Society.

  1. Sleeve gastrectomy and gastro-oesophageal reflux disease: a complex relationship.

    Science.gov (United States)

    Mahawar, Kamal K; Jennings, Neil; Balupuri, Shlok; Small, Peter K

    2013-07-01

    Sleeve gastrectomy is rapidly becoming popular as a standalone bariatric operation. At the same time, there are valid concerns regarding its long-term durability and postoperative gastro-oesophageal reflux disease. Though gastric bypass remains the gold standard bariatric operation, it is not suitable for all patients. Sleeve gastrectomy is sometimes the only viable option. Patients with inflammatory bowel disease, liver cirrhosis, significant intra-abdominal adhesions involving small bowel and those reluctant to undergo gastric bypass could fall in this category. It is widely recognised that some patients report worsening of their gastro-oesophageal reflux disease after sleeve gastrectomy. Still, others develop de novo reflux. This review examines if it is possible to identify these patients prior to surgery and thus prevent postoperative gastro-oesophageal reflux disease after sleeve gastrectomy.

  2. De novo gastric adenocarcinoma 1 year after sleeve gastrectomy in a transplant patient

    Directory of Open Access Journals (Sweden)

    M. Masrur

    2016-01-01

    Conclusions: No direct relation has been established between sleeve gastrectomy and the development of gastric cancer. Robotic procedures allow for complex multiorgan resections, while preserving the benefits of minimally invasive surgery.

  3. Endoluminal stenting for the management of leak following sleeve gastrectomy and loop duodenojejunal bypass with sleeve gastrectomy.

    Science.gov (United States)

    Tsai, Ying-Nan; Wang, Hsiu-Po; Huang, Chih-Kun; Chang, Po-Chin; Lin, I-Chang; Tai, Chi-Ming

    2018-01-01

    Postoperative leak is a serious complication of bariatric surgery and often results in significant morbidity and mortality. Stent placement is a less invasive alternative to surgery for the treatment of bariatric surgical leak. We evaluated the efficacy and complications of covered self-expandable metal stents (SEMS) in the treatment of post-bariatric surgical leak. We retrospectively reviewed patients who underwent stent placement for leak after bariatric surgery. Leak was diagnosed by upper gastrointestinal series or was visualized during the endoscopy. We examined the timing of stent placement, size of the leak, stent migration and its complications, total stent treatment duration, and treatment outcome. Between January 2011 and April 2015, seven patients underwent covered SEMS placement for leak after bariatric surgery, including laparoscopic sleeve gastrectomy (LSG) (n = 5) and laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) (n = 2). A stent was placed in one patient for infection control and bridging to revisional surgery. Among the other six patients, one patient who received stent placement one year after leak diagnosis failed to achieve leak closure, and five patients with early stent placement achieved leak closure. Three patients with small leak achieved leak closure more quickly. Stent migration was found in six patients, and associated ulcers occurred in five patients. We conclude that stenting is effective in the management of staple-line leaks following LSG and LDJB-SG. Stent migration and associated ulcers are common after stent placement. Early stent removal can be achieved in patients with small leaks. Copyright © 2017. Published by Elsevier Taiwan.

  4. Endoluminal stenting for the management of leak following sleeve gastrectomy and loop duodenojejunal bypass with sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Ying-Nan Tsai

    2018-01-01

    Full Text Available Postoperative leak is a serious complication of bariatric surgery and often results in significant morbidity and mortality. Stent placement is a less invasive alternative to surgery for the treatment of bariatric surgical leak. We evaluated the efficacy and complications of covered self-expandable metal stents (SEMS in the treatment of post-bariatric surgical leak. We retrospectively reviewed patients who underwent stent placement for leak after bariatric surgery. Leak was diagnosed by upper gastrointestinal series or was visualized during the endoscopy. We examined the timing of stent placement, size of the leak, stent migration and its complications, total stent treatment duration, and treatment outcome. Between January 2011 and April 2015, seven patients underwent covered SEMS placement for leak after bariatric surgery, including laparoscopic sleeve gastrectomy (LSG (n = 5 and laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG (n = 2. A stent was placed in one patient for infection control and bridging to revisional surgery. Among the other six patients, one patient who received stent placement one year after leak diagnosis failed to achieve leak closure, and five patients with early stent placement achieved leak closure. Three patients with small leak achieved leak closure more quickly. Stent migration was found in six patients, and associated ulcers occurred in five patients. We conclude that stenting is effective in the management of staple-line leaks following LSG and LDJB-SG. Stent migration and associated ulcers are common after stent placement. Early stent removal can be achieved in patients with small leaks.

  5. Acute Pancreatitis with Splenic Infarction as Early Postoperative Complication following Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Aleksandr Kalabin

    2017-01-01

    Full Text Available Obesity is becoming a global health burden along with its comorbidities. It imposes tremendous financial burden and health costs worldwide. Surgery has emerged as the definitive treatment option for morbidly obese patients with comorbidities. Laparoscopic sleeve gastrectomy is performed now more than ever making it imperative for physicians and surgeons to recognize both the common and the uncommon risks and complications associated with it. In this report we describe a rare early life-threatening postoperative complication following laparoscopic sleeve gastrectomy. From our extensive review of literature, there is no existing report of acute pancreatitis with splenic infarction postsleeve gastrectomy to this date.

  6. Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention

    OpenAIRE

    Nath, Anand; Yewale, Sayali; Tran, Tung; Brebbia, John S; Shope, Timothy R; Koch, Timothy R

    2016-01-01

    AIM To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG). METHODS VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single insti...

  7. Food Tolerance and Quality of Alimentation Following Laparoscopic Sleeve Gastrectomy Calibrated with a 50-Fr Bougie: Long-Term Results.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Bozhychko, Maryana; Del-Campo, Jone Miren; Zubiaga, Lorea; Llavero, Carolina

    2018-04-02

    Adjustable gastric banding and vertical banded gastroplasty are associated with the worst postoperative food tolerance of all bariatric techniques. However, food tolerance tends to improve over time. The aim of this study was to assess food tolerance and diet quality in patients undergoing a sleeve gastrectomy, 1 and 5 years after surgery. A prospective observational study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy was performed. Food tolerance was assessed using the Quality of Alimentation questionnaire validated in bariatric patients. Ninety-three patients were analyzed. One year after surgery, mean excess weight loss (EWL) was 81.1% ± 8.3%, and 5 years after surgery, mean EWL was 79.9% ± 6.4%. Preoperatively, 39.8% of patients perceived their eating patterns as good or excellent, 1 year after surgery, 79.6% and 5 years postoperatively, 86%. One year after surgery, the patients reported some difficulty in tolerance of rice, pasta, and red meat. Five years after surgery, these difficulties disappeared and very few patients just refer some tolerance difficulties with red meat. One year after surgery, 10% of the patients reported that they suffered postprandial vomiting often and 22% rarely. Five years postoperatively, only 8% of subjects describe rarely vomiting. After sleeve gastrectomy, the patients recognize an improvement in the quality of alimentation. During the first postoperative year, they present tolerance problems with rice, pasta, and red meat, and that disappeared 5 years after surgery.

  8. Dietary intake and ghrelin and leptin changes after sleeve gastrectomy.

    Science.gov (United States)

    Bužga, Marek; Zavadilová, Vladislava; Holéczy, Pavol; Švagera, Zdeněk; Švorc, Pavol; Foltys, Aleš; Zonča, Pavel

    2014-12-01

    Surgical intervention in obesity is today the most effective treatment method in high level obesity management. Bariatric interventions not only ensure body weight reduction, but may influence dietary habits. To assess changes in adipose hormones and dietary habits in obese patients after sleeve gastrectomy. The study set comprised 37 subjects (29 females and 8 males) 24 to 68 years old with body mass index 43.0 ±4.9 kg/m(2). Pre-operative examination included baseline measurements of body composition. Dietary habits and intake frequency were monitored by a questionnaire method. Follow-up examinations were carried out in a scope identical to the pre-operative examination, 6 and 12 months after surgery, respectively. The average patient weight loss 12 months after surgery was 31.7 kg. Excess weight loss was 55.2 ±20.6%. Patients reported reduced appetite (p meal portions per day (p = 0.003) and a decrease in consuming the largest portions during the afternoon and evening (p = 0.030). Plasma levels of fasting glucose, leptin and ghrelin significantly decreased (p = 0.006; p = 0.0.043); in contrast, the level of adiponectin significantly increased (p weight reduction within 1 year after surgery. An improvement of certain dietary habits in patients was registered. At 12 months after surgery, there were no statistically significant differences in decreases in ghrelin and leptin concentrations between patients without changed appetite and those reporting decreased appetite.

  9. Complications, Reoperations, and Nutrient Deficiencies Two Years after Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Nicole Pech

    2012-01-01

    Full Text Available Background. The aim of this study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a follow-up of two years. Methods. Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included operative time, complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results. From September 26, 2005 to May 28, 2009, 82 patients (female : male = 48 : 34 with a mean age of 43.3 years (range: 22–64 and a preoperative BMI of 52.5 kg/m² (range: 36.8–77.0 underwent SG. Major complications were observed in 9.8% of the patients, with 1 death. During follow up 51.2% of patients were supplemented with iron, 36.6% with zinc, 37.8% with calcium, 26.8% with vitamin D, 46.3% with vitamin B12 and 41.5% with folic acid. %EWL was 54.3, 65.3 and 62.6% after 6, 12 and 24 months. Conclusion. SG as a single step procedure is an effective bariatric intervention. Nutritional deficiencies after SG can be detected by routine nutritional screening. Our results show that Vitamin B12 supplementation should suggest routinely after SG.

  10. Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention.

    Science.gov (United States)

    Nath, Anand; Yewale, Sayali; Tran, Tung; Brebbia, John S; Shope, Timothy R; Koch, Timothy R

    2016-12-21

    To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG). VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage. Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids. Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.

  11. Analgesic Effect of Intraperitoneal Bupivacaine Hydrochloride After Laparoscopic Sleeve Gastrectomy: a Randomized Clinical Trial.

    Science.gov (United States)

    Alamdari, Nasser Malekpour; Bakhtiyari, Mahmood; Gholizadeh, Barmak; Shariati, Catrine

    2018-03-01

    The indications for sleeve gastrectomy as a primary procedure for the surgical treatment of morbid obesity have increased worldwide. Pain is the most common complaint for patients on the first day after laparoscopic sleeve gastrectomy. There are various methods for decreasing pain after laparoscopic sleeve gastrectomy such as the use of intraperitoneal bupivacaine hydrochloride. This clinical trial was an attempt to discover the effects of intraperitoneal bupivacaine hydrochloride on alleviating postoperative pain after laparoscopic sleeve gastrectomy. In general, 120 patients meeting the inclusion criteria were enrolled. Patients were randomly allocated into two interventions and control groups using a balanced block randomization technique. One group received intraperitoneal bupivacaine hydrochloride (30 cm 3 ), and the other group served as the control one and did not receive bupivacaine hydrochloride. Diclofenac suppository and paracetamol injection were administered to both groups for postoperative pain management. The mean subjective postoperative pain score was significantly decreased in patients who received intraperitoneal bupivacaine hydrochloride within the first 24 h after the surgery; thus, the instillation of bupivacaine hydrochloride was beneficial in managing postoperative pain. The intraoperative peritoneal irrigation of bupivacaine hydrochloride (30 cm 3 , 0.25%) in sleeve gastrectomy patients was safe and effective in reducing postoperative pain, nausea, and vomiting (IRCT2016120329181N4).

  12. Alcohol consumption after laparoscopic sleeve gastrectomy: 1-year results.

    Science.gov (United States)

    Coluzzi, Ilenia; Iossa, Angelo; Spinetti, Elena; Silecchia, Gianfranco

    2018-02-06

    Laparoscopic sleeve gastrectomy (SG) represents, at present, the most performed bariatric procedure worldwide with excellent long-term results on weight loss and comorbidities control. After the gastrectomy procedure, together with hormonal modification, several changes in taste and habits occur, including the potential modification in alcohol consumption. The aim of this prospective study was to determine the frequency and the amount of alcohol use before and after SG using a modified version of the Alcohol Use Disorder Identification Test (AUDIT) at 1-year follow-up and eventually to evaluate relationships between different ages and sexes. A total of 142 patients were prospectively enrolled and evaluated before and 1 year after SG with a modified AUDIT. The exclusion criteria were as follows: history of alcohol abuse, presence of psychopathology or cognitive impairments, diabetes mellitus type II decompensated, or previous gastrointestinal, liver, and pancreatic resective surgery. Subgroup analyses were performed between male and female and between under and over 40 years old. The median AUDIT score decreased from 2.70 (range 1-18) before surgery to 1.38 (range 1-7) after 1 year of SG, indicating a marked reduction in alcohol use. The most consumed alcoholic drink was beer (36.6%/n = 52) while after surgery the consumption of beer decreased considerably (21.1%/n = 30). The frequency of alcohol consumption also decreased: at baseline 45% of patients consumed alcoholic drinks "from 2 to 4 times per month", whereas 26 and 39.4% consumed alcohol "never" and "less than once a month," respectively. After surgery, nobody consumed more then six alcoholic drinks. No differences were found between the subgroups in terms of alcohol consumption and social behavior. The alcohol preference is modified and decreased 1 year after SG and this could be related to the strict nutritional follow-up and to the hormonal changes. Studies with large samples and long

  13. Nutritional Status Prior to Laparoscopic Sleeve Gastrectomy Surgery.

    Science.gov (United States)

    Sherf Dagan, Shiri; Zelber-Sagi, Shira; Webb, Muriel; Keidar, Andrei; Raziel, Asnat; Sakran, Nasser; Goitein, David; Shibolet, Oren

    2016-09-01

    Two main causes for nutrient deficiencies following bariatric surgery (BS) are pre-operative deficiencies and favoring foods with high-energy density and poor micronutrient content. The aims of this study were to evaluate nutritional status and gender differences and the prevalence of nutritional deficiencies among candidates for laparoscopic sleeve gastrectomy (LSG) surgery. A cross-sectional analysis of pre-surgery data collected as part of a randomized clinical trial on 100 morbidly obese patients with non-alcoholic fatty liver disease (NAFLD) admitted to LSG surgery at Assuta Medical Center between February 2014 and January 2015. Anthropometrics, food intake, and fasting blood tests were evaluated during the baseline visit. One-hundred patients completed the pre-operative measurements (60 % female) with a mean age of 41.9 ± 9.8 years and a mean BMI of 42.3 ± 4.7 kg/m(2). Pre-operatively, deficiencies for iron, ferritin, folic acid, vitamin B1, vitamin B12, vitamin D, and hemoglobin were 6, 1, 1, 6, 0, 22, and 6 %, respectively. Pre-surgery, mean energy, protein, fat, and carbohydrate intake were 2710.7 ± 1275.7 kcal/day, 114.2 ± 48.5, 110.6 ± 54.5, and 321.6 ± 176.1 gr/day, respectively. The intakes for iron, calcium, folic acid, vitamin B12, and vitamin B1 were below the Dietary Reference Intake (DRI) recommendations for 46, 48, 58, 14, and 34 % of the study population, respectively. We found a low prevalence of nutritional deficiencies pre-operatively except for vitamin D. Most micronutrient intake did not reach the DRI recommendations, despite high-caloric and macronutrient intake indicating a poor dietary quality.

  14. Long-term nutritional impact of sleeve gastrectomy.

    Science.gov (United States)

    Caron, M; Hould, F S; Lescelleur, O; Marceau, S; Lebel, S; Julien, F; Simard, S; Biertho, Laurent

    2017-10-01

    Sleeve gastrectomy (SG) has become a predominant bariatric procedure throughout the world. However, the long-term nutritional impact of this procedure is unknown. To describe the nutritional deficiencies before and after SG and to analyze the influence of baseline weight on nutritional status. University-affiliated tertiary care center. All patients who underwent SG as a standalone procedure between 2008 and 2012 were included in this study. Patients were given multivitamin supplementation. Data were obtained from our prospectively maintained electronic database and are reported as mean ± standard deviation and percentage. Bivariate analyses were conducted to evaluate the influence of selected variables on outcomes. The mean age of the 537 patients was 48.0 ± 11.3 years, with an initial body mass index of 48.1 ± 8.7 kg/m 2 . Excess weight loss and total weight loss were 56.2% and 28.0% at 1 year and 43.0% and 21.1% at 5 years, respectively (Pvitamin B12 in 30.3% and 16.4% (Pvitamin D 63.2% and 24.3% (Pvitamin A insufficiency peaked from 7.9% preoperatively to 28.7% at 3 months (Pvitamin B12 and vitamin D. Nutritional deficiencies are common in patients with morbid obesity before and after surgery. Preoperative supplementation and long-term nutritional follow-up are required to prevent nutritional deficiencies. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  15. Complications and nutrient deficiencies two years after sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Pech Nicole

    2012-07-01

    Full Text Available Abstract Background The aim of this systematic study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a median follow-up of two years. Methods Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results From September 26, 2005 to May 28, 2009, 100 patients (female: male = 59:41 with a mean age of 43.6 years (range: 22–64 and a preoperative BMI of 52.3 kg/² (range: 36–77 underwent SG. The mean operative time was 86.4 min (range: 35–275. Major complications were observed in 8.0 % of the patients. During the follow-up period, 25 patients (25.0 % underwent a second bariatric intervention (22 DS and 3 RYGBP. Out of the total 100 patients, 48 % were supplemented with iron, 33 % with zinc, 34 % with a combination of calcium carbonate and cholecalciferol, 24 % with vitamin D, 42 % with vitamin B12 and 40 % with folic acid. The patients who received only a SG (n = 75 had %EWL of 53.6, 65.8 and 62.6 % after 6, 12 and 24 months, respectively. Conclusions SG is a highly effective bariatric intervention for morbidly obese patients. Nutritional deficiencies resulting from the procedure can be detected by routine nutritional screening. Results of the study show that Vitamin B12 supplementation should suggested routinely.

  16. Self-Regulation of Weight After Sleeve Gastrectomy.

    Science.gov (United States)

    Madeira, Teresa; do Carmo, Isabel; Bicha Castelo, Henrique; Santos, Osvaldo

    2018-03-01

    Bariatric surgery is recognized as the most effective method for achieving relevant weight loss in subjects with severe obesity. However, there is insufficient knowledge about weight self-regulation and quality of motivation in these patients. The main goal of this study was to characterize the association between the percentage of excess weight loss (%EWL) and the motivation to manage weight, at least 1 year after sleeve gastrectomy (SG). This is an observational longitudinal retrospective study. All patients corresponding to predefined inclusion criteria who underwent SG from January 2008 to July 2010 at a main general hospital were invited. A version of the Treatment Self-Regulation Questionnaire (TSRQ) was used to assess patients' quality of motivation: TSRQ concerning continuing the weight self-management program. Clinical data were collected from patients' records. Overall, 81 patients participated (16 men and 65 women, 25-64 years old). The average body mass index was significantly reduced from 45.3 ± 7.0 kg/m 2 preoperatively to 32.7 ± 6.9 kg/m 2 postoperatively. Autonomous self-regulation was higher than externally controlled self-regulation, regarding motives to keep managing weight after SG. Postoperatively, %EWL correlated negatively with external self-regulation. SG was found to be associated with the quality of motivation for losing weight. External motivations were associated with worse results. These findings support the importance of multiprofessional teams in the assessment and treatment of patients, aiming for the promotion of weight self-regulation after bariatric surgery.

  17. Laparoscopic sleeve gastrectomy in patients over 59 years: early recovery and 12-month follow-up.

    Science.gov (United States)

    Leivonen, Marja Kaarina; Juuti, Anne; Jaser, Nabil; Mustonen, Harri

    2011-08-01

    Bariatric surgery has shown to be safe for patients over 60 years with good results especially considering resolving of comorbidities. Sleeve gastrectomy is considered to be safer than gastric bypass (GBP) and more effective than gastric banding with less adverse symptoms. Weight loss may be more modest than after GBP, but the effect on vitamins may also be milder. Since 2007, we collected prospectively 12-month follow-up data from 55 sleeve gastrectomy patients of whom 12 were over 59 years of age. Vitamin and calcium supplements were used postoperatively. The recovery from the operation was recorded during hospital stay, at 1- and 12-month follow-up visits using a standard protocol including laboratory tests. The results between patients over and under 59 years were compared. The preoperative weight and weight loss were comparable between the groups. Operation time was shorter and hospital stay was longer for older patients, p = ns. There was no operative mortality. Early major complications were seen more often in the older age group, 42% vs 9% (p = 0.02), but late complications were more common in younger patients, 17% vs 44%, p = ns. Early complications were mostly bleedings, which did not lengthen the hospital stay, neither were re-operations nor endoscopic procedures needed. Excess weight loss and resolving of comorbidities after 12 months was comparable between the groups. However, vitamin deficiencies and hypoalbuminemia were more common in the older age group, 42% and 23% for vitamins and 44% and 29% for proteins, p = ns. The older patients had more adverse effects related to surgery, 25% vs 9%, and younger had more adverse psychiatric effects, p = ns. Sleeve gastrectomy is effective and safe for older bariatric patients. Weight loss is comparable to younger patients and enough to resolve the comorbidities in most of the patients. With standardized nutritional supplementation, the older patients had more often vitamin deficiencies and

  18. Management of Distal Gastric Leak After Laparoscopic Sleeve Gastrectomy by Double Pigtail Catheter

    Directory of Open Access Journals (Sweden)

    Mani Habibi

    2016-07-01

    Full Text Available Gastric leakage postsurgery is the most feared complication of laparoscopic sleeve gastrectomy due to the difficulty of its management. While gastric leakagemanagement postsurgery is often performed using internal drainage catheters accompanied by self-expandable metal stents, endoscopic internal drainage by double pigtail catheter has recently become a recommended approach. Here we describe our treatment of a patient who experienced distal gastric leakage after undergoing laparoscopic sleeve gastrectomy using double pigtail catheter and our treatment recommendations based on the patient outcome.

  19. Preoperative endoscopy may reduce the need for revisional surgery for gastro-oesophageal reflux disease following laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Madhok, B M; Carr, W R J; McCormack, C; Boyle, M; Jennings, N; Schroeder, N; Balupuri, S; Small, P K

    2016-08-01

    Laparoscopic sleeve gastrectomy is a safe and effective bariatric operation, but postoperative reflux symptoms can sometimes necessitate revisional surgery. Roux-en-Y gastric bypass is the preferred operation in morbidly obese patients with gastro-oesophageal reflux disease. In 2011, we introduced preoperative endoscopy to assess for hiatus hernia or evidence of oesophagitis in conjunction with an assessment of gastro-oesophageal reflux symptoms for all patients undergoing bariatric surgery with a view to avoid sleeve gastrectomy for these patients. A prospectively maintained database was used to identify patients who underwent sleeve gastrectomy before and after we changed the unit policy. The need for revisional surgery in patients with troublesome gastro-oesophageal reflux disease was examined. Prior to 2011, 130 patients underwent sleeve gastrectomy, and 11 (8.5%) of them required conversion to Roux-en-Y gastric bypass for symptomatic reflux disease. Following the policy change, 284 patients underwent sleeve gastrectomy, and to date, only five (1.8%) have required revisional surgery (p = 0.001). Baseline demographics were comparable between the groups, and average follow-up period was 47 and 33 months, respectively, for each group. Preoperative endoscopy and a detailed clinical history regarding gastro-oesophageal reflux symptoms may improve patient selection for sleeve gastrectomy. Avoiding sleeve gastrectomy in patients with reflux disease and/or hiatus hernia may reduce the incidence of revisional surgery. © 2016 World Obesity.

  20. Portal vein thrombosis after laparoscopic sleeve gastrectomy: presentation and management.

    Science.gov (United States)

    Belnap, LeGrand; Rodgers, George M; Cottam, Daniel; Zaveri, Hinali; Drury, Cara; Surve, Amit

    2016-12-01

    Portal vein thrombosis (PVT) is a serious problem with a high morbidity and mortality, often exceeding 40% of affected patients. Recently, PVT has been reported in patients after laparoscopic sleeve gastrectomy (LSG). The frequency is surprisingly high compared with other abdominal operations. We present a series of 5 patients with PVT after LSG. The treatment was not restricted simply to anticoagulation alone, but was determined by the extent of disease. A distinction is made among nonocclusive, high-grade nonocclusive, and occlusive PVT. We present evidence that systemic anticoagulation is insufficient in occlusive thrombosis and may also be insufficient in high-grade nonocclusive disease. Single private institution, United States. We present a retrospective analysis of 646 patients who underwent LSG between 2012 and 2015. In all patients, the diagnosis was established with an abdominal computed tomography (CT) scan as well as duplex ultrasound of the portal venous system. All patients received systemic anticoagulation. Depending on the extent of disease, thrombolytic therapy and portal vein thrombectomy were utilized. All patients received long-term anticoagulation. Four patients with PVT were identified. A fifth patient with PVT after LSG was referred from another center. The mean age of all patients was 49 years. One patient had a history of deep vein thrombosis (DVT). No complications were identified intraoperatively or during the hospital stay, and all patients were discharged by postoperative day 2. The patients presented with PVT at an average of 20 days (range: 10-35) post-LSG. The CT scan was positive for PVT in all patients. In stable noncirrhotic patients with nonocclusive disease, we administered therapeutic anticoagulation. One patient with high-grade, nonocclusive PVT received anticoagulation alone. Patients with occlusive disease were treated with operative thrombectomy including intraoperative and postoperative thrombolysis (tissue plasminogen

  1. Gastroesophageal Reflux Management with the LINX® System for Gastroesophageal Reflux Disease Following Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Desart, Kenneth; Rossidis, Georgios; Michel, Michael; Lux, Tamara; Ben-David, Kfir

    2015-10-01

    Laparoscopic sleeve gastrectomy (LSG) has gained significant popularity in the USA, and consequently resulted in patients experiencing new-onset gastroesophageal reflux disease (GERD) following this bariatric procedure. Patients with GERD refractory to medical therapy present a more challenging situation limiting the surgical options to further treat the de novo GERD symptoms since the gastric fundus to perform a fundoplication is no longer an option. The aim of this study is to determine if the LINX® magnetic sphincter augmentation system is a safe and effective option for patients with new gastroesophageal reflux disease following laparoscopic sleeve gastrectomy. This study was conducted at the University Medical Center. This is a retrospective review of seven consecutive patients who had a laparoscopic LINX® magnetic sphincter device placement for patients with refractory gastroesophageal reflux disease after laparoscopic sleeve gastrectomy between July 2014 and April 2015. All patients were noted to have self-reported greatly improved gastroesophageal reflux symptoms 2-4 weeks after their procedure. They were all noted to have statistically significant improved severity and frequency of their reflux, regurgitation, epigastric pain, sensation of fullness, dysphagia, and cough symptoms in their postoperative GERD symptoms compared with their preoperative evaluation. This is the first reported pilot case series, illustrating that the LINX® device is a safe and effective option in patients with de novo refractory gastroesophageal reflux disease after a laparoscopic sleeve gastrectomy despite appropriate weight loss.

  2. Effect of vertical sleeve gastrectomy in melanocortin receptor 4-deficient rats

    NARCIS (Netherlands)

    Mul, J.D.; Begg, D.P.; Alsters, S.I.; van Haaften, G.; Duran, K.J.; D'Alessio, D.A.; le Roux, C.W.; Woods, S.C.; Sandoval, D.A.; Blakemore, A.I.; Cuppen, E.; van Haelst, M.M.; Seeley, R.J.

    2012-01-01

    Bariatric surgery is currently the most effective treatment for obesity. Vertical sleeve gastrectomy (VSG), a commonly applied bariatric procedure, involves surgically incising most of the volume of the stomach. In humans, partial loss of melanocortin receptor-4 (MC4R) activity is the most common

  3. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease : a systematic review and meta-analysis

    NARCIS (Netherlands)

    Oor, Jelmer E; Roks, David J; Ünlü, Çagdas; Hazebroek, Eric J

    BACKGROUND: The effect of sleeve gastrectomy (SG) on the prevalence of gastroesophageal reflux disease (GERD) remains unclear. We aimed to outline the currently available literature. DATA SOURCES: All relevant databases were searched for publications examining the effect of laparoscopic SG on GERD.

  4. The Effects of Bougie Diameters on Tissue Oxygen Levels After Sleeve Gastrectomy: A Randomized Experimental Trial

    Directory of Open Access Journals (Sweden)

    Can Konca

    2018-05-01

    Full Text Available Background: Staple-line leak is the most frightening complication of laparoscopic sleeve gastrectomy and several predisposing factors such as using improper staple sizes regardless of gastric wall thickness, narrower bougie diameter and ischemia of the staple line are asserted. Aims: To evaluate the effects of different bougie diameters on tissue oxygen partial pressure at the esophagogastric junction after sleeve gastrectomy. Study Design: A randomized and controlled animal experiment with 1:1:1:1 allocation ratio. Methods: Thirty-two male Wistar Albino rats were randomly divided into 4 groups of 8 each. While 12-Fr bougies were used in groups 1 and 3, 8-Fr bougies were used in groups 2 and 4. Fibrin sealant application was also carried out around the gastrectomy line after sleeve gastrectomy in groups 3 and 4. Burst pressure of gastrectomy line, tissue oxygen partial pressure and hydroxyproline levels at the esophagogastric junction were measured and compared among groups. Results: Mortality was detected in 2 out of 32 rats (6.25% and one of them was in group 2 and the cause of this mortality was gastric leak. Gastric leak was detected in 2 out of 32 rats (6.25%. There was no significant difference in terms of burst pressures, tissue oxygen partial pressure and tissue hydroxyproline levels among the 4 groups. Conclusion: The use of narrower bougie along with fibrin sealant has not had a negative effect on tissue perfusion and wound healing.

  5. Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention

    Science.gov (United States)

    Nath, Anand; Yewale, Sayali; Tran, Tung; Brebbia, John S; Shope, Timothy R; Koch, Timothy R

    2016-01-01

    AIM To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG). METHODS VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage. RESULTS Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids. CONCLUSION Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients. PMID:28058017

  6. Laparoscopic hand-assisted versus robotic-assisted laparoscopic sleeve gastrectomy: experience of 103 consecutive cases.

    Science.gov (United States)

    Kannan, Umashankkar; Ecker, Brett L; Choudhury, Rashikh; Dempsey, Daniel T; Williams, Noel N; Dumon, Kristoffel R

    2016-01-01

    Laparoscopic sleeve gastrectomy has become a stand-alone procedure in the treatment of morbid obesity. There are very few reports on the use of robotic approach in sleeve gastrectomy. The purpose of this retrospective study is to report our early experience of robotic-assisted laparoscopic sleeve gastrectomy (RALSG) using a proctored training model with comparison to an institutional cohort of patients who underwent laparoscopic hand-assisted sleeve gastrectomy (LASG). University hospital. The study included 108 patients who underwent sleeve gastrectomy either via the laparoscopic-assisted or robot-assisted approach during the study period. Of these 108 patients, 62 underwent LASG and 46 underwent RALSG. The console surgeon in the RALSG is a clinical year 4 (CY4) surgery resident. All CY4 surgery residents received targeted simulation training before their rotation. The console surgeon is proctored by the primary surgeon with assistance as needed by the second surgeon. The patients in the robotic and laparoscopic cohorts did not have a statistical difference in their demographic characteristics, preoperative co-morbidities, or complications. The mean operating time did not differ significantly between the 2 cohorts (121 min versus 110 min, P = .07). Patient follow-up in the LSG and RALSG were 91% and 90% at 3 months, 62% and 64% at 6 months, and 60% and 55% at 1 year, respectively. The mean percentage estimated weight loss (EWL%) at 3 months, 6 months, and 1 year was greater in the robotic group but not statistically significant (27 versus 22 at 3 mo [P = .05] and 39 versus 34 at 6 mo [P = .025], 57 versus 48 at 1 yr [P = .09]). There was no mortality in either group. Early results of our experience with RALSG indicate low perioperative complication rates and comparable weight loss with LASG. The concept of a stepwise education model needs further validation with larger studies. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc

  7. [Outcomes, controversies and gastric volume after laparoscopic sleeve gastrectomy in the treatment of obesity].

    Science.gov (United States)

    García-Díaz, Juan José; Ferrer-Márquez, Manuel; Moreno-Serrano, Almudena; Barreto-Rios, Rogelio; Alarcón-Rodríguez, Raquel; Ferrer-Ayza, Manuel

    2016-01-01

    Laparoscopic sleeve gastrectomy is a surgical procedure for the treatment of morbid obesity. However, there are still controversies regarding its efficiency in terms of weight reduction and incidence of complications. In this prospective study, the experience is presented of a referral centre for the treatment of morbid obesity with laparoscopic sleeve gastrectomy. A prospective study on 73 patients subjected to laparoscopic sleeve gastrectomy from February 2009 to September 2013. Patients were followed-up for a period of 12 months, evaluating the development of complications, reduction of gastric volume, and the weight loss associated with the surgery, as well as their impact on the improvement of comorbidities present at beginning of the study. There was a statistically a significantly reduction between the preoperative body mass index (BMI) and the BMI at 12 months after laparoscopic sleeve gastrectomy (p < 0.001), despite there being an increase in the gastric volume during follow-up, measured at one month and 12 months after surgery (p < 0.001). Five patients (6.85%) had complications, with none of them serious and with no deaths in the whole series. Laparoscopic sleeve gastrectomy is a safe and effective technique for the treatment of morbid obesity. Its use is associated with a significant reduction in the presence of comorbidities associated with obesity. Multicentre studies with a longer period of monitoring are required to confirm the efficacy and safety of this surgical technique. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  8. Intraoperative leak testing has no correlation with leak after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Sethi, Monica; Zagzag, Jonathan; Patel, Karan; Magrath, Melissa; Somoza, Eduardo; Parikh, Manish S; Saunders, John K; Ude-Welcome, Aku; Schwack, Bradley F; Kurian, Marina S; Fielding, George A; Ren-Fielding, Christine J

    2016-03-01

    Staple line leak is a serious complication of sleeve gastrectomy. Intraoperative methylene blue and air leak tests are routinely used to evaluate for leak; however, the utility of these tests is controversial. We hypothesize that the practice of routine intraoperative leak testing is unnecessary during sleeve gastrectomy. A retrospective cohort study was designed using a prospectively collected database of seven bariatric surgeons from two institutions. All patients who underwent sleeve gastrectomy from March 2012 to November 2014 were included. The performance of intraoperative leak testing and the type of test (air or methylene blue) were based on surgeon preference. Data obtained included BMI, demographics, comorbidity, presence of intraoperative leak test, result of test, and type of test. The primary outcome was leak rate between the leak test (LT) and no leak test (NLT) groups. SAS version 9.4 was used for univariate and multivariate analyses. A total of 1550 sleeve gastrectomies were included; most were laparoscopic (99.8%), except for one converted and two open cases. Routine intraoperative leak tests were performed in 1329 (85.7%) cases, while 221 (14.3%) did not have LTs. Of the 1329 cases with LTs, there were no positive intraoperative results. Fifteen (1%) patients developed leaks, with no difference in leak rate between the LT and NLT groups (1 vs. 1%, p = 0.999). After adjusting for baseline differences between the groups with a propensity analysis, the observed lack of association between leak and intraoperative leak test remained. In this cohort, leaks presented at a mean of 17.3 days postoperatively (range 1-67 days). Two patients with staple line leaks underwent repeat intraoperative leak testing at leak presentation, and the tests remained negative. Intraoperative leak testing has no correlation with leak due to laparoscopic sleeve gastrectomy and is not predictive of the later development of staple line leak.

  9. 'Stent in a stent'--an alternative technique for removing partially covered stents following sleeve gastrectomy complications.

    Science.gov (United States)

    Vasilikostas, Georgios; Sanmugalingam, Nimalan; Khan, Omar; Reddy, Marcus; Groves, Chris; Wan, Andrew

    2014-03-01

    Endoscopic stenting is a relatively new technique for the treatment of post sleeve gastrectomy complications. Partially covered stents are used in this method to minimise the risk of migration but they are associated with difficulties with removal. Patients requiring emergency stenting following sleeve gastrectomy underwent insertion of a partially covered metallic stent. One month later, if the stent was not easily removable, a fully covered overlapping stent was inserted and the patient was readmitted 2 weeks later for removal of both stents. Four patients required stenting following sleeve gastrectomy leaks, and one patient required stenting for a stricture. In these cases, a 'stent in a stent' technique was used for removal. This technique allows the safe removal of partially covered stents inserted following sleeve gastrectomy complications.

  10. Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test.

    Science.gov (United States)

    Mans, Esther; Serra-Prat, Mateu; Palomera, Elisabet; Suñol, Xavier; Clavé, Pere

    2015-09-01

    The relation between hunger, satiation, and integrated gastrointestinal motility and hormonal responses in morbidly obese patients after sleeve gastrectomy has not been determined. The objective was to assess the effects of sleeve gastrectomy on hunger, satiation, gastric and gallbladder motility, and gastrointestinal hormone response after a liquid meal test. Three groups were studied: morbidly obese patients (n = 16), morbidly obese patients who had had sleeve gastrectomy (n = 8), and nonobese patients (n = 16). The participants fasted for 10 h and then consumed a 200-mL liquid meal (400 kcal + 1.5 g paracetamol). Fasting and postprandial hunger, satiation, hormone concentrations, and gastric and gallbladder emptying were measured several times over 4 h. No differences were observed in hunger and satiation curves between morbidly obese and nonobese groups; however, sleeve gastrectomy patients were less hungry and more satiated than the other groups. Antrum area during fasting in morbidly obese patients was statistically significant larger than in the nonobese and sleeve gastrectomy groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results). Gallbladder emptying was similar in the 3 groups. Sleeve gastrectomy patients showed the lowest ghrelin concentrations and higher early postprandial cholecystokinin and glucagon-like peptide 1 peaks than did the other participants. This group also showed an improved insulin resistance pattern compared with morbidly obese patients. Sleeve gastrectomy seems to be associated with profound changes in gastrointestinal physiology that contribute to reducing hunger and increasing sensations of satiation. These changes include accelerated gastric emptying, enhanced postprandial cholecystokinin and glucagon-like peptide 1 concentrations, and reduced ghrelin release, which together may help patients lose weight and improve their glucose metabolism after

  11. Simple, Safe, and Cost-Effective Technique for Resected Stomach Extraction in Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Derici, Serhan; Atila, Koray; Bora, Seymen; Yener, Serkan

    2016-01-01

    Background. Laparoscopic sleeve gastrectomy (LSG) has become a popular operation during the recent years. This procedure requires resection of 80-90% of the stomach. Extraction of gastric specimen is known to be a challenging and costly stage of the operation. In this paper, we report results of a simple and cost-effective specimen extraction technique which was applied to 137 consecutive LSG patients. Methods. Between October 2013 and October 2015, 137 laparoscopic sleeve gastrectomy surgeries were performed at Dokuz Eylul University General Surgery Department, Upper Gastrointestinal Surgery Unit. All specimens were extracted through a 15 mm trocar site without using any special device. Results. We noticed one superficial incisional surgical site infection and treated this patient with oral antibiotics. No cases of trocar site hernia were observed. Conclusion. Different techniques have been described for specimen extraction. This simple technique allows extraction of specimen safely in a short time and does not require any special device.

  12. The weight is over: RN first assisting techniques for laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Wentzell, Joanne; Neff, Marc

    2015-08-01

    Obesity-related laparoscopic sleeve gastrectomy is a common yet technically challenging bariatric procedure that requires specialized surgical knowledge and training for OR personnel. Critical components of care include an effective preoperative assessment, positioning of the patient, and operation and maintenance of laparoscopic equipment and instrumentation. The purpose of this article is to explain the steps of laparoscopic sleeve gastrectomy and illustrate principles and surgical techniques for the RN who is first assisting during the procedure. Also provided is a perioperative nursing care plan for the patient undergoing bariatric surgery, to aid perioperative nurses in understanding the sequence of events and special considerations for this patient population. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  13. The success of sleeve gastrectomy in the management of metabolic syndrome and obesity

    OpenAIRE

    Shabbir, Asim; Dargan, Dallan

    2014-01-01

    Abstract The rapid reversal of diabetes, hypertension, hyperlipidaemia and obesity by surgical means has challenged accepted doctrines regarding the management of metabolic syndrome. Sleeve gastrectomy, which developed initially as a preparatory procedure for biliopancreatic diversion with duodenal switch, has seen an exponential rise in popularity as an effective lone laparoscopic bariatric procedure. Superior excess weight loss, a low complication rate, and excellent food tolerance, combine...

  14. Randomized, Prospective Comparison of Ursodeoxycholic Acid for the Prevention of Gallstones after Sleeve Gastrectomy.

    Science.gov (United States)

    Adams, Lindsay B; Chang, Craig; Pope, Janet; Kim, Yeonsoo; Liu, Pei; Yates, Amy

    2016-05-01

    Several studies have examined the role of ursodeoxycholic acid (UDCA) for the prevention of cholelithiasis (gallstones) following rapid weight loss from restrictive diets, vertical band gastroplasty, and Roux-en-Y gastric bypass. However, to date, there have been no prospective, controlled studies examining the role of UDCA for the prevention of gallstones following sleeve gastrectomy (SG). This study was conducted to identify the effectiveness of UDCA for prevention of gallstones after SG. Following SG, eligible patients were randomized to a control group who did not receive UDCA treatment or to a group who were prescribed 300 mg UDCA twice daily for 6 months. Gallbladder ultrasounds were performed preoperatively and at 6 and 12 months postoperatively. Patients with positive findings preoperatively were excluded from the study. Compliance with UDCA was assessed. Between December 2011 and April 2013, 37 patients were randomized to the UDCA treatment arm and 38 patients were randomized to no treatment. At baseline, the two groups were similar. At 6 months, the UDCA group had a statistically significant lower incidence of gallstones (p = 0.032). Analysis revealed no significant difference in gallstones between the two groups at 1 year (p = 0.553 and p = 0.962, respectively). The overall gallstone formation rate was 29.8%. The incidence of gallstones is higher than previously estimated in SG patients. UDCA significantly lowers the gallstone formation rate at 6 months postoperatively.

  15. Laparoscopic sleeve gastrectomy for morbid obesity with natural orifice specimen extraction (NOSE).

    Science.gov (United States)

    Gunkova, P; Gunka, I; Zonca, P; Dostalik, J; Ihnat, P

    2015-01-01

    An experience with laparoscopic sleeve gastrectomy using the natural orifice specimen extraction (NOSE) technique. Bariatric surgery is nowadays the only long term effective obesity treatment method. Twenty one consecutive patients underwent laparoscopic sleeve gastrectomy with the use of natural orifice specimen extraction (NOSE) in the Surgical Clinic of Faculty Hospital Ostrava between May 2012 and August 2012. Inclusion criteria were the body mass index (BMI) higher than 35 kg/m2 or higher than 32 kg/m2 accompanied with relevant comorbidities. Among 21 patients in this series, there were three men (14.3%) and 18 women (85.7%). Their mean age was 40.9±10.2 years. Their mean preoperative BMI was 40.4±4.6 kg/m2. No patient had previous bariatric surgery, one patient had laparoscopic fundoplication. All operations were completed laparoscopically with no conversions to an open procedure. In two cases, laparoscopic cholecystectomy was performed and the gallbladder was extracted along with the gastric specimen by transgastric approach. Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure with low morbidity and mortality. Based on our initial experiences it could be an indication for NOSE with transgastric approach. Obese patients would benefit from this approach due to the elimination of wound complications (Tab. 2, Fig. 3, Ref. 22).

  16. A Delphi Consensus of the Crucial Steps in Gastric Bypass and Sleeve Gastrectomy Procedures in the Netherlands.

    Science.gov (United States)

    Kaijser, Mirjam A; van Ramshorst, Gabrielle H; Emous, Marloes; Veeger, Nic J G M; van Wagensveld, Bart A; Pierie, Jean-Pierre E N

    2018-04-09

    Bariatric procedures are technically complex and skill demanding. In order to standardize the procedures for research and training, a Delphi analysis was performed to reach consensus on the practice of the laparoscopic gastric bypass and sleeve gastrectomy in the Netherlands. After a pre-round identifying all possible steps from literature and expert opinion within our study group, questionnaires were send to 68 registered Dutch bariatric surgeons, with 73 steps for bypass surgery and 51 steps for sleeve gastrectomy. Statistical analysis was performed to identify steps with and without consensus. This process was repeated to reach consensus of all necessary steps. Thirty-eight participants (56%) responded in the first round and 32 participants (47%) in the second round. After the first Delphi round, 19 steps for gastric bypass (26%) and 14 for sleeve gastrectomy (27%) gained full consensus. After the second round, an additional amount of 10 and 12 sub-steps was confirmed as key steps, respectively. Thirteen steps in the gastric bypass and seven in the gastric sleeve were deemed advisable. Our expert panel showed a high level of consensus expressed in a Cronbach's alpha of 0.82 for the gastric bypass and 0.87 for the sleeve gastrectomy. The Delphi consensus defined 29 steps for gastric bypass and 26 for sleeve gastrectomy as being crucial for correct performance of these procedures to the standards of our expert panel. These results offer a clear framework for the technical execution of these procedures.

  17. SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY AND HIV.

    Science.gov (United States)

    Pinto, José Máximo Costa; Lima, Marianna Gomes Cavalcanti Leite de; Almeida, Ana Luiza Melo Cavalcanti de; Sousa, Marcelo Gonçalves

    It is estimated that there are nearly 40 million people with the human immunodeficiency virus (HIV) worldwide. Due to the advent of antiretroviral drugs, it has been observed increasing in obesity and metabolic rates among patients undergoing treatment. Thus, numerous surgical therapies for weight loss are proposed for continuous improvement in health of patients with HIV, being the vertical gastrectomy an option for intact intestinal transit. To evaluate the applicability of the vertical gastrectomy in patients with morbid obesity and HIV. Was conducted a systematic review of the literature, in the electronic databases Scopus, Pubmed, Cinahl, Scielo, Cochrane and Lilacs, from 1998 to 2015. MeSH headings used in data collection were "Gastrectomy" and "Morbid obesity" being combined with the descriptor "HIV". Were found 2148 articles in Scopus, 1234 in PubMed and 784 in Cinahl. The articles were analyzed by the Jadad Quality Scale, being reduced to 40 articles, subsequently reassessed using an elaborated form by the Critical Appraisal Skills Programme (CASP), reaching 12 articles in the end. It was found that vertical gastrectomy constitutes a safe and effective method, with low mortality and low rate of postoperative complications, being recommended as surgical technique in patients with obesity, HIV and comorbidities. Estima-se que haja quase 40 milhões de pessoas com o vírus da imunodeficiência adquirida (HIV) no mundo. Com o advento dos antirretrovirais, observou-se aumento da obesidade e de taxas metabólicas nos pacientes em tratamento. Assim, inúmeras terapias cirúrgicas para a perda de peso estão sendo estudadas para a melhoria contínua da saúde dos pacientes com HIV, sendo a gastrectomia vertical uma opção de trânsito íntegro. Avaliar a aplicabilidade da gastrectomia vertical em pacientes com obesidade mórbida e HIV. Foi realizada revisão sistemática de literatura, de artigos publicados nas bases eletrônicas de dados Scopus, Pubmed, Cinahl

  18. More stapler firings increase the risk of perioperative morbidity after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Major, Piotr; Wysocki, Michał; Pędziwiatr, Michał; Pisarska, Magdalena; Małczak, Piotr; Wierdak, Mateusz; Dembiński, Marcin; Migaczewski, Marcin; Rubinkiewicz, Mateusz; Budzyński, Andrzej

    2018-03-01

    Staple-line bleeding and leakage are the most common serious complications of laparoscopic sleeve gastrectomy. The relationship between multiple stapler firings and higher risk of postoperative complications is well defined in colorectal surgery but has not been addressed in bariatric procedures so far. Identification of new factors such as "the numbers of stapler firings used during laparoscopic sleeve gastrectomy (LSG)" as a predictor for complications can lead to optimization of the patient care at bariatric centers. To determine the association between perioperative morbidity and the number of stapler firings during laparoscopic sleeve gastrectomy. This observational study was based on retrospective analysis of prospectively collected data in patients operated on for morbid obesity in a teaching hospital/tertiary referral center for general surgery. The patients who underwent LSG were analyzed in terms of the number of stapler firings used as a new potential risk predictor for postoperative complications after surgery, adjusting for other patient- and treatment-related factors. The study included 333 patients (209 women, 124 men, mean age: 40 ±11). During the first 30 days after surgery, complications were observed in 18 (5.41%) patients. Multivariate analysis showed that prolonging operative time increased morbidity (every minute, OR = 1.01; 95% CI: 1.00-1.02) and the complication rate increased with the number of stapler firings (every firing, OR = 1.91; 95% CI: 1.09-3.33; p = 0.023). Additional stapler firings above the usual number and a prolonged operation should alert a surgeon and the whole team about increased risk of postoperative complications.

  19. pH monitoring of gastro-oesophageal reflux before and after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Thereaux, J; Barsamian, C; Bretault, M; Dusaussoy, H; Lamarque, D; Bouillot, J-L; Czernichow, S; Carette, C

    2016-03-01

    Gastro-oesophageal reflux disease (GORD) is a common obesity-related co-morbidity that is assessed objectively by 24-h pH monitoring. Some concerns have been raised regarding the risk of de novo GORD or exacerbation of pre-existing GORD after laparoscopic sleeve gastrectomy. Here, 24-h pH monitoring was used to assess the influence of laparoscopic sleeve gastrectomy on postoperative GORD in obese patients with or without preoperative GORD. From July 2012 to September 2014, all patients scheduled for laparoscopic sleeve gastrectomy were invited to participate in a prospective follow-up. Patients who underwent preoperative 24-h pH monitoring were asked to repeat the examination 6 months after operation. GORD was defined as an oesophageal pH < 4 for at least 4·2 per cent of the total time recorded. Of 89 patients, 76 had preoperative pH monitoring for GORD evaluation and 50 had postoperative reassessment. Patients without (group 1, 29 patients) or with (group 2, 21 patients) preoperative GORD were similar regarding age, sex ratio and body mass index. In group 1, the median (i.q.r.) total time at pH < 4 was significantly higher after surgery than before: 5·6 (2·5-9·5) versus 1·6 (0·7-2·9) per cent (P < 0·001). Twenty of the 29 patients experienced de novo GORD as determined by 24-h pH monitoring (P < 0·001). In group 2, total time at pH < 4 after surgery was no different from the preoperative value: 5·9 (3·9-10·7) versus 7·7 (5·2-10·3) per cent (P = 0·296). Laparoscopic sleeve gastrectomy was associated with de novo GORD in over two-thirds of patients, but did not seem to exacerbate existing GORD. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

  20. FXR is a molecular target for the effects of vertical sleeve gastrectomy

    DEFF Research Database (Denmark)

    Ryan, Karen K; Tremaroli, Valentina; Clemmensen, Christoffer

    2014-01-01

    Bariatric surgical procedures, such as vertical sleeve gastrectomy (VSG), are at present the most effective therapy for the treatment of obesity, and are associated with considerable improvements in co-morbidities, including type-2 diabetes mellitus. The underlying molecular mechanisms contributing......-X receptor, also known as NR1H4). We therefore examined the results of VSG surgery applied to mice with diet-induced obesity and targeted genetic disruption of FXR. Here we demonstrate that the therapeutic value of VSG does not result from mechanical restriction imposed by a smaller stomach. Rather, VSG...

  1. Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis.

    Science.gov (United States)

    Clapp, Benjamin; Wynn, Matthew; Martyn, Colin; Foster, Chase; O'Dell, Montana; Tyroch, Alan

    2018-03-06

    The laparoscopic sleeve gastrectomy is now the most common bariatric operation in the United States and has become an established procedure in the armamentarium of the bariatric surgeon. However, this has happened without the strong support of long-term outcomes data, namely the rate of revision and durability of the weight loss. Newly published data from around the world are starting to show alarming trends in these 2 areas. This paper will examine the published and presented data with at least a 7-year follow-up. This is a meta-analysis on published data with at least 7 years of follow-up from the laparoscopic sleeve gastrectomy. Online published articles. We performed a meta-analysis of publications with at least 7 years of follow-up with the keywords "laparoscopic, bariatric, sleeve gastrectomy, sleeve, long-term, long, term, results, follow-up, follow up, conversion, 7 years, 8 years, 9 years, 10 years, 11 years." We queried the PubMed, MEDLINE, and ClinicalKey search engines, which included abstracts as well. The I 2 statistic was used to determine the heterogeneity across the studies. In presence of heterogeneity, a random effect model using the Dersimonian and Laird method was used to estimate the pooled estimates. The results were summarized using effect size along with a 95% confidence interval (CI). Meta-regression was also used to assess the effect of body mass index and follow-up years on the incidence of recidivism at ≥7 years. Nine cohort studies met the inclusion criteria, with a total of 2280 patients included initially. Only 652 patients had completed ≥7 years of follow-up. At ≥7 years, the long-term weight recidivism rate was estimated to be 27.8% (I 2 = .60%; 95% CI: 22.8%-32.7%) with a range of 14% to 37%. The overall revision rate was estimated to be 19.9% (I 2 = 93.8%; 95% CI: 11.3%-28.5%). This was broken down into 13.1% (I 2 = 93.8%; 95% CI: 5.6%-20.6%) due to weight regain (5 studies) and 2.9% (I 2 = 60.8%; 95% CI: 1%-4.9%) due to

  2. A multicenter study of routine versus selective intraoperative leak testing for sleeve gastrectomy.

    Science.gov (United States)

    Bingham, Jason; Kaufman, Jedediah; Hata, Kai; Dickerson, James; Beekley, Alec; Wisbach, Gordon; Swann, Jacob; Ahnfeldt, Eric; Hawkins, Devon; Choi, Yong; Lim, Robert; Martin, Matthew

    2017-09-01

    Staple line leaks after sleeve gastrectomy are dreaded complications. Many surgeons routinely perform an intraoperative leak test (IOLT) despite little evidence to validate the reliability, clinical benefit, and safety of this procedure. To determine the efficacy of IOLT and if routine use has any benefit over selective use. Eight teaching hospitals, including private, university, and military facilities. A multicenter, retrospective analysis over a 5-year period. The efficacy of the IOLT for identifying unsuspected staple line defects and for predicting postoperative leaks was evaluated. An anonymous survey was also collected reflecting surgeons' practices and beliefs regarding IOLT. From January 2010 through December 2014, 4284 patients underwent sleeve gastrectomy. Of these, 37 patients (.9%) developed a postoperative leak, and 2376 patients (55%) received an IOLT. Only 2 patients (0.08%) had a positive finding. Subsequently, 21 patients with a negative IOLT developed a leak. IOLT demonstrated a sensitivity of only 8.7%. There was a nonsignificant trend toward increased leak rates when an IOLT was performed versus when IOLT was not performed. Leak rates were not statistically different between centers that routinely perform IOLT versus those that selectively perform IOLT. Routine IOLT had very poor sensitivity and was negative in 91% of patients who later developed postoperative leaks. The use of IOLT was not associated with a decrease in the incidence of postoperative leaks, and routine IOLT had no benefit over selective leak testing. IOLT should not be used as a quality indicator or "best practice" for bariatric surgery. Published by Elsevier Inc.

  3. The appearance of a lurking ligament in Laparoscopic Sleeve Gastrectomy; Posterior Gastric Ligament

    Directory of Open Access Journals (Sweden)

    Mutlu Ünver

    2017-03-01

    Full Text Available Objective: The aim of this study was to demonstrate a lurking ligament and its various formation types and to mention the importance of this ligament in Laparoscopic sleeve gastrectomy Methods: One hundred and twelve patients had laparoscopic sleeve gastrectomy (LSG procedure in our clinic between March 2011 and September 2013. All procedures were performed with a standard operative technique. Only difference for the last 50 patients was to avoid the excessive dissection of posterior gastric wall. The existence of posterior gastric ligament was recorded and different types of posterior gastric ligament was demonstrated. Results: Posterior gastric ligament was observed in all of the cases in different formation types. Three types of ligament; complete, partial and skippy, was demonstrated. 53(47.3% of the patients had skippy, while 41 (36.6% had partial and 18 (16.1% had complete type of posterior gastric ligament. Conclusion: A ligament named as ‘posterior gastric ligament’ and its various forms were defined in the third dimensional plane of stomach. Posterior gastric ligament remains as the only structure in LSG for preventing the mobility and ability of the stomach to rotate. The excessive dissection of the posterior gastric ligament should be avoided to prevent complications such as kinking and volvulus

  4. Gastritis in patients undergoing sleeve gastrectomy: Prevalence, ethnic distribution, and impact on glycemic.

    Science.gov (United States)

    Rath-Wolfson, Lea; Varona, Roy; Bubis, Golan; Tatarov, Alexander; Koren, Rumelia; Ram, Edward

    2017-04-01

    Laparoscopic sleeve gastrectomy (LSG) is a therapeutic option in severely obese patients. The aim of this study was to evaluate the presence of Helicobacter pylori (HP) gastritis and non-Helicobacter gastritis in the gastrectomy specimens, and its association to other variables.One hundred six sleeve gastrectomy specimens were examined histopathologically for the presence of gastritis and its relation to other factors like ethnicity, glycemic control, and postoperative complications.Twelve patients had HP gastritis, 39 had non-HP gastritis, and 55 had normal mucosa. There was a statistical difference between the Arab and Jewish Israeli patients in our study. Twenty-eight of the Arab patients had HP gastritis and 48% had non-HP gastritis. In the Jewish population 6% had HP gastritis and 34% had non-HP gastritis. The preoperative glycemic control was worse in the gastritis group with a mean HbA1c of 8.344% while in the normal mucosa group the mean HbA1c was 6.55. After operation the glycemic control reverted to normal in most the diabetic patients. There were few postoperative complications however, they were not related to HP.There is a high incidence of gastritis in obese patients. The incidence of gastritis in the Arab population in our study was higher than that in the Jewish population. The glycemic control before surgery was worse in patients with gastritis than in the normal mucosa group. HP bares no risk for postoperative complications after LSG and does not affect weight loss. However a larger cohort of patients must be studied to arrive at conclusive results.

  5. Feasibility and early outcomes of laparoscopic plicated sleeve gastrectomy: a case-control study

    Directory of Open Access Journals (Sweden)

    Tomasz Rogula

    2016-01-01

    Full Text Available Introduction : Sleeve gastrectomy (SG continues to gain popularity as a viable weight loss procedure with well-documented outcomes and procedure-specific adverse effects. It has become increasingly indicated for the treatment of morbid obesity. Aim of the research : To compare a novel approach to SG, which aims to reduce SG-specific complications, to the standard SG procedure. Material and methods : Sixteen morbidly obese patients with a mean body mass index (BMI of 48.5 kg/m 2 ± SD who underwent the novel laparoscopic plicated sleeve gastrectomy (LPSG were retrospectively studied. The control group included 18 patients who underwent laparoscopic SG. Study and control groups were matched for BMI and gender. Study group patients underwent a partial SG with imbrication of the distal 2/3 of the staple line with 2 cm overlap and 3–4 cm of the pre-pyloric stomach. Control group SG patients had their staple line oversewn without plication. Outcomes at 3, 6 and 12 months were compared and analyzed. Results: There was no statistically significant difference in weight loss at 12 months between the LPSG and SG groups. Postoperative nausea was comparable between the two groups. No major complications were noted in either group. Conclusions: The LPSG is a modification of the standard SG which has comparable outcomes, safety and feasibility. It may lead to a decrease in unwanted complications such as sleeve stricture or obstruction. Further studies on long-term outcomes are needed to assess its value as a bariatric procedure.

  6. Concurrent Mesh Repair of a Morgagni and Umbilical Hernia during a Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Individual

    Directory of Open Access Journals (Sweden)

    N.R Kosai

    2016-10-01

    Full Text Available Morgagni Hernia is a rare form of diaphragmatic hernia. It is mainly asymptomatic and often identified incidentally during surgery. Tension-free synthetic mesh repair is the preferred treatment modality. However, the use of synthetic mesh concurrently during a clean-contaminated surgery such as sleeve gastrectomy remains controversial due to the remote possibility of mesh infection. A middle-aged female 2 with BMI of 47 Kg/m was admitted electively for laparoscopic sleeve gastrectomy with concurrent umbilical hernia repair. Intra-operatively, a left Morgagni Hernia containing omentum and a segment of transverse colon was noted. She underwent a laparoscopic sleeve gastrectomy and simultaneous laparoscopic tension-free composite mesh repair of both Morgagni and umbilical hernia. Outpatient review three months later revealed excess weight loss of almost 30% with no recurrence of either hernia. In conclusion, the advantages of concurrent hernia repair during bariatric surgery outweigh the risk of mesh infection and should be performed to prevent future risk of visceral herniation and strangulation. Laparoscopic mesh repair of a Morgagni Hernia and umbilical hernia in the setting of an electively planned sleeve gastrectomy is feasible, effective and safe in the hands of a trained laparoscopic surgeon.

  7. Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

    Directory of Open Access Journals (Sweden)

    Ezri Tiberiu

    2015-04-01

    Full Text Available Background: Incomplete muscle relaxant reversal or re-curarization may be associated with postoperative respiratory complications. In this retrospective study we compared the incidence of postoperative residual curarization and respiratory complications in association with the type of muscle relaxant reversal agent, sugammadex or neostigmine, in patients undergoing laparoscopic sleeve gastrectomy.

  8. Resident education in robotic-assisted vertical sleeve gastrectomy: outcomes and cost-analysis of 411 consecutive cases.

    Science.gov (United States)

    Ecker, Brett L; Maduka, Richard; Ramdon, Andre; Dempsey, Daniel T; Dumon, Kristoffel R; Williams, Noel N

    2016-02-01

    Robotic technology is increasingly prevalent in bariatric surgery, yet there are national deficiencies in exposure of surgical residents to robotic techniques. The purpose of this study is to accurately characterize the perioperative outcomes of a resident teaching model using the robotic-assisted sleeve gastrectomy. University Hospital. We identified 411 consecutive patients who underwent robotic sleeve gastrectomy at our institution from a prospectively maintained administrative database. Perioperative morbidity, operative time, and supply cost of the procedure were analyzed. Mean operative time was 96.4±24.9 minutes; mean robot usage time was 63.9 minutes (range 30.0-122.0 min). Ninety-day morbidities included reoperation (0.72%), major bleeding complications (0.48%), staple line leak (0.24%), stricture (0.97%), need for blood transfusion (3.86%), surgical site infection (1.69%), deep vein thrombosis (0.48%), and pulmonary embolism (0.48%). Mortality was nil. The resident cohort achieved operative time plateaus after five consecutive cases. Subset analysis for fiscal year 2014 demonstrated significantly increased supply cost for robotic sleeve gastrectomy compared with its laparoscopic equivalent. Robotic-assisted sleeve gastrectomy can be instituted as a model for resident robotic education with rates of morbidity and operative times equivalent to historical laparoscopic controls. The robot's enhanced ergonomics and its opportunity for resident education must be weighed against its increased supply cost. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. Endoscopic Treatment of Early Gastric Obstruction After Sleeve Gastrectomy: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Mariana Nuno Costa

    2016-01-01

    Full Text Available Morbid obesity is an epidemic and complex disease which imposes a multidisciplinary approach. Laparoscopic sleeve gastrectomy has become a frequent procedure given its efficacy and safety compared to other surgical options. However, it isn’t free from complications. Lax gastric fixation or incorrect positioning of the stomach during surgery can result in early gastric outlet obstruction caused by a volvulus-like mechanism by rotation of the stomach around its anatomic axes. This report refers to two cases of post sleeve gastric torsion resulting in persisting vomiting after initiating oral intake. The diagnosis was confirmed by upper gastrointestinal-contrast study and gastroscopy. In both cases, a fully covered self-expandable metallic stent was inserted which prompted the gastric lumen to become permeable resulting in symptomatic resolution. The stents were removed endoscopically after two and three months. Beyond more than three years of follow-up, the patients remain asymptomatic and no recurring “stenosis” was noticed. In these cases the use of fully covered self-expandable metallic stents demonstrated to be effective and safe in the treatment of post sleeve gastric torsion.

  10. Sleeve gastrectomy severe complications: is it always a reasonable surgical option?

    Science.gov (United States)

    Moszkowicz, David; Arienzo, Roberto; Khettab, Idir; Rahmi, Gabriel; Zinzindohoué, Franck; Berger, Anne; Chevallier, Jean-Marc

    2013-05-01

    Laparoscopic sleeve gastrectomy (LSG) is widely adopted but exposes serious complications. A retrospective database analysis was done to study LSG staple line complications in a tertiary referral university center with surgical ICU experienced in treatment of morbid obesity and complications. Twenty-two consecutive patients were referred between January 2004 and February 2012 with postoperative gastric leak or stenosis after LSG. Interventions consisted in the control of intra-abdominal and general sepsis; restoration of staple line continuity or revision of LSG; nutritional support; treatment of associated complications. Main outcome measures concerned success rates of therapeutic strategies, morbidity and mortality rates, LOS, and time to cure. Thirteen patients (59 %) were referred after failure of reoperation (seven fistula repairs were attempted). Three patients received emergency surgery in our center with transorificial intubation and jejunostomy formation. An endoscopic stent was tried in nine patients but failed in 84.6 % of cases within 20 days (1-161). Seven patients (32 %) necessitated total gastrectomy within 217 days (0-1,915 days) for conservative treatment failure. Procedures under general anesthesia were required in 41 % of cases, organ failure was found in 55 % of cases, and central venous device infection in 40 %. Mortality rate was 4.5 % (n = 1). Patients with unfavorable evolution of LSG complications (death or additional gastrectomy) had more previous bariatric procedure (82 % vs. 18 %, p = 0.003). Median time to cure was 310 days (9-546 days). LSG exposes severe complications occurring in patients with benign condition. Endoscopic stents entail high failure rate. Total gastrectomy is required in one third of the cases.

  11. Laparoscopic sleeve gastrectomy achieves substantial weight loss in an adolescent girl with morbid obesity.

    Science.gov (United States)

    Till, H K-H; Muensterer, O; Keller, A; Körner, A; Blueher, S; Merkle, R; Kiess, W

    2008-02-01

    The European guidelines for bariatric surgery clearly define criteria for operating children with morbid obesity. However the appropriate technique for this age-group has not been identified yet. So far gastric banding and Roux-Y bypass represent the standards, but they demand life-long tolerance of either an artificial device or significant malabsorption. Although laparoscopic sleeve gastrectomy (LSG) demands neither, it has not been advocated for this age-group as a stand-alone technique. We report the outcome and the rationale for this approach in a 16-year-old girl with morbid obesity. The patient had been in an intensive weight loss programme for several years, but within the last 12 months her body weight had increased again dramatically. At referral she presented with a body mass index (BMI) of 43.1 kg/m(2) (height 169 cm, preoperative weight 121 kg) and suffered from co-morbidities as features of a developing metabolic-vascular syndrome such as dyslipidemia and arterial hypertension. Our obesity team and her parents opted for surgery at that time. The patient underwent LSG with a 5-trocar technique. With a gastroscope protecting the lesser curvature, the stomach was resected from the antrum to the fundus using an EndoGIA stapler. The operative time was 95 minutes, there were no perioperative complications and the patient was extubated immediately. An upper GI contrast study on postoperative day 4 showed a tubular gastric remnant with a volume of about 200 ml. The patient's diet was advanced as tolerated to full oral intake, and she was followed-up regularly in our special obesity outpatient clinic. After 12 months she had lost 36 kg (BMI 29 kg/m(2)) and enjoyed sports and activities with friends again. Laboratory studies ruled out malnutrition or vitamin deficiency. LSG is a safe and effective option for bariatric surgery in obese adolescents. It can be offered as a stand-alone restrictive operation and could be extended to a malabsorptive procedure at any

  12. Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery.

    Science.gov (United States)

    Saif, Taha; Strain, Gladys W; Dakin, Gregory; Gagner, Michel; Costa, Ricardo; Pomp, Alfons

    2012-01-01

    Laparoscopic sleeve gastrectomy evolved as a primary bariatric procedure with little information on its nutritional effects. Our objective was to assess the longer term micronutrient and vitamin status after laparoscopic sleeve gastrectomy at a university hospital. Measurements of ferritin, iron, total iron binding capacity, hemoglobin, hematocrit, parathyroid hormone, albumin, calcium, magnesium, phosphorus, zinc, folate, and vitamins A, B1, B12, and D were obtained at baseline and 1, 3, and 5 years after surgery. Two-sample t tests with multiple adjusted comparisons and Fisher's exact test were used to determine deficiency. A total of 82 patients (67% women), with a mean age of 46.4 years and a baseline body mass index 55.7 kg/m2 were included in the present study (35 at 1, 27 at 3, and 30 at 5 years postoperatively). The percentage of excess body mass index loss was 58.5% at year 1 in 35 patients, 63.1% at year 3 in 27 patients, and 46.1% at year 5 in 30 patients. The parathyroid hormone level decreased from 75.0 to 49.6 ng/mL in year 1 to 40.7 ng/mL in year 3. The year 5 levels increased to 99.6 ng/mL. The mean vitamin D level increased from 23.6 ng/mL to 35.0, 32.1 and 34.8 at years 1, 3, and 5 (P = .05 for baseline to year 1). The vitamin D level was less than normal in 42% of the patients at year 5. After normalization from baseline, by year 5, parathyroid hormone had increased in 58.3% of patients. At year 5, vitamin B1 was less than normal in 30.8% of patients, and hemoglobin and hematocrit were less than normal in for 28.6% and 25% of patients, respectively. Finally, 28.9% of patients reported taking supplements in year 1, 42.9% in year 3, and 63.3% in year 5. The other variables were not significantly different. Laparoscopic sleeve gastrectomy resulted in health improvements through year 3. At year 5, the nutrient levels had reverted toward the baseline values. These observations provide focus for necessary clinical monitoring. Copyright © 2012 American

  13. The impact of selected factors on parameters of weight loss after sleeve gastrectomy.

    Science.gov (United States)

    Binda, Artur; Jaworski, Paweł; Kudlicka, Emilia; Ciesielski, Adam; Cabaj, Hubert; Tarnowski, Wiesław

    2016-01-01

    The effectiveness of sleeve gastrectomy has been confirmed in many studies. The impact of individual factors on the parameters of weight loss is still not clear. To identify important factors affecting the parameters of weight loss after sleeve gastrectomy. The impact of prognostic factors and postoperative care components on body mass index (BMI) and percentage excess weight loss (%EWL) was assessed in a group of 100 consecutive patients who underwent laparoscopic sleeve gastrectomy. The baseline BMI and body mass in patients with BMI < 30 kg/m 2 and BMI ≥ 30 kg/m 2 12 months after surgery were, respectively, 39.7 ±3.2 vs. 45.9 ±4.6 kg/m 2 , p < 0.0001, and 114.4 ±16.8 vs. 130.3 ±18.5 kg, p < 0.0001. In the group with EWL < 50%, the average age was 47.1 ±7.7 vs. 40.6 ±10.8 in the group with EWL ≥ 50%, p = 0.0025. In the group of patients with preoperative weight loss, %EWL was 61.4 ±17.2 vs. 53.3 ±19.3% in the group with no weight loss, p = 0.0496. Body mass index of the patients who started physical activities was 30.6 ±4.2 kg/m 2 vs. 34.0 ±5.6 kg/m 2 in the patients with no physical activity, p = 0.0013, and %EWL was 63.4 ±14.6 vs. 47.0 ±19.9%, p < 0.0001, respectively. In the case of patients regularly consulted by a dietician BMI was 30.6 ±4.2 kg/m 2 vs. 35.1 ±5.5 kg/m 2 in the group without systematic consultations, p < 0.0001, and %EWL was 63.1 ±15.1% vs. 42.3 ±18.2%, p < 0.0001. Lower baseline body weight parameters, younger age, preoperative weight loss, starting systematic physical activities and constant care of a dietician were conducive to achieving better results of surgery, as assessed on the basis of changes in BMI and %EWL.

  14. Gastric wall thickness and stapling in laparoscopic sleeve gastrectomy - a literature review.

    Science.gov (United States)

    Barski, Krzysztof; Binda, Artur; Kudlicka, Emilia; Jaworski, Paweł; Tarnowski, Wiesław

    2018-03-01

    Despite the growing experience of bariatric surgeons in performing laparoscopic sleeve gastrectomy, the number of complications involving staple line leaks remains constant. Hence a solution to avoid such complications is still sought. A defect of the staple line may be the consequence of an inappropriate choice of staple size in relation to gastric wall thickness. Due to the variable nature of gastric wall thickness, the choice of proper staple height is not obvious. In the few studies in which gastric wall thickness was measured, it was observed to decrease gradually from the antrum to the fundus. However, the authors are divided on the issue of whether gender and body mass index influence gastric wall thickness. The question whether there are other perioperative factors that would allow gastric wall thickness to be predicted remains unanswered.

  15. Leak or Fistula After Sleeve Gastrectomy: Treatment with Pigtail Drain by the Rendezvous Technique.

    Science.gov (United States)

    Soufron, Jacques

    2015-10-01

    After a sleeve gastrectomy, a leak or fistula is a serious complication. Laparoscopic drainage, drainage under US or CT scan control, or endoscopic insertion of a stent can be used, but a major re-operation is sometimes unavoidable. Endoscopic drainage with a pigtail catheter could give more success and fewer complications, but the insertion of the drain is not always possible nor does it always provide a perfect drainage. If a laparoscopic second look appears necessary, it is possible to insert a pigtail drain laparoscopically, but under endoscopic control, ensuring a correct positioning of the drain both in the peritoneal cavity and in the gastric tube. This simultaneous "rendezvous" technique could combine in this situation the advantages of purely surgical techniques and of purely endoscopic or image-guided techniques.

  16. Portomesenteric venous thrombosis after laparoscopic sleeve gastrectomy: A case report and a call for prevention

    Directory of Open Access Journals (Sweden)

    Parveen Bhatia

    2015-01-01

    Full Text Available Postoperative portomesenteric venous thrombosis (PMVT is being increasingly reported after bariatric surgery. It is variable and often a nonspecific presentation along with its potential for life-threatening and life-altering outcomes makes it imperative that it is prevented, detected early and treated optimally. We report the case of a 50-year-old morbidly obese man undergoing a laparoscopic sleeve gastrectomy who developed symptomatic PMVT two weeks postsurgery, which was successfully treated by anticoagulant therapy. We provide postulates to the etiopathological mechanism for this thrombotic entity. The growing recognition that obesity and bariatric surgery create a procoagulant state regionally and systemically provides impetus for designing the ideal protocol for PMVT prophylaxis, which could be more common than currently believed. We support the early screening for PMVT in the postbariatric surgical patient with unexplainable or intractable abdominal symptoms. The role of routine surveillance and the ideal duration of post-PMVT anticoagulation is yet to be elucidated.

  17. Mechanistic comparison between gastric bypass vs. duodenal switch with sleeve gastrectomy in rat models.

    Directory of Open Access Journals (Sweden)

    Yosuke Kodama

    Full Text Available BACKGROUND: Both gastric bypass (GB and duodenal switch with sleeve gastrectomy (DS have been widely used as bariatric surgeries, and DS appears to be superior to GB. The aim of this study was to better understand the mechanisms leading to body weight loss by comparing these two procedures in experimental models of rats. METHODS: Animals were subjected to GB, DS or laparotomy (controls, and monitored by an open-circuit indirect calorimeter composed of comprehensive laboratory animal monitoring system and adiabatic bomb calorimeter. RESULTS: Body weight loss was greater after DS than GB. Food intake was reduced after DS but not GB. Energy expenditure was increased after either GB or DS. Fecal energy content was increased after DS but not GB. CONCLUSION: GB induced body weight loss by increasing energy expenditure, whereas DS induced greater body weight loss by reducing food intake, increasing energy expenditure and causing malabsorption in rat models.

  18. Impact of laparoscopic sleeve gastrectomy on body mass index, ghrelin, insulin and lipid levels in 100 obese patients

    OpenAIRE

    Hady, Hady Razak; Dadan, Jacek; Go?aszewski, Pawe?; Safiejko, Kamil

    2012-01-01

    Introduction A high percentage of patients benefit from bariatric procedures in terms of metabolic effect and substantial body mass reduction. These procedures improve glucose metabolism leading to the amelioration or complete resolution of type 2 diabetes, reduction of insulin resistance and alleviation of metabolic syndrome effects. Aim To assess the impact of laparoscopic sleeve gastrectomy (LSG) on the plasma levels of ghrelin, insulin, glucose, triglycerides, total cholesterol, high-dens...

  19. Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: Incidence, Analysis and Follow-Up in 1236 Consecutive Cases

    OpenAIRE

    Villagr?n, Rodrigo; Smith, Gabriela; Rodriguez, Walter; Flores, Carlos; Cariaga, Mario; Araya, Sof?a; Ya?ez, Marisol; Fuentes, Paulina; Linares, Jeannette; Zapata, Antonio

    2016-01-01

    Background Portomesenteric vein thrombosis (PMVT) is a rare but severe complication after laparoscopic bariatric surgery, with potentially serious consequences. We aimed to describe the incidence, clinical features, management, outcome, and midterm follow-up in patients with PMVT after laparoscopic sleeve gastrectomy (LSG). Methods This retrospective and descriptive study included patients who underwent LSG between November 2009 and July 2015 and developed PMVT. The following data were analyz...

  20. Sleeve gastrectomy leads to easy management of hormone replacement therapy and good weight loss in patients treated for craniopharyngioma.

    Science.gov (United States)

    Trotta, Manuela; Da Broi, Joël; Salerno, Angelo; Testa, Rosa M; Marinari, Giuseppe M

    2017-03-01

    The aim of this study is to investigate the effects of sleeve gastrectomy on hormone replacement therapy and on hypothalamic obesity in patients affected by craniopharyngioma with post-surgical pan-hypopituitarism. A retrospective review of three patients, treated for hypothalamic obesity with laparoscopic sleeve gastrectomy, who have previously undergone surgery for craniopharyngioma in their childhood, was done. Patients' mean age and BMI were 22.3 years (range 21-24) and 49.2 kg/m 2 (range 41.6-58.1), respectively. The mean time of delay between neurosurgery and bariatric surgery was 12.3 years (range 6-16). There were no major complications or deaths. At 24 months follow-up, the mean BMI was 35.3 kg/m 2 (range 31.2-40.6). No hydrocortisone and sex steroids dose changes were observed, while levothyroxine was decreased in two patients. Growth hormone replacement therapy was increased in two patients, whereas it was started in one patient. Desmopressin was significantly decreased in all of them. Patients with surgically induced pan-hypopituitarism after craniopharyngioma who become obese, can expect good results from sleeve gastrectomy: this procedure does not have significant negative effects on hormone substitution and leads to a good stabilization of body weight in a mid-term follow-up.

  1. Ultrasound-guided subcostal-posterior transversus abdominis plane block for pain control following laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Dilek E. Arı

    2017-12-01

    Full Text Available Objectives: To investigate the analgesic effect of a subcostal-posterior transversus abdominis plane (TAP block combination following laparoscopic sleeve gastrectomy. Methods: This study was conducted at Fatih Sultan Mehmet Educational and Research Hospital, Istanbul, Turkey, between March 2014 and June 2015. A total of 40 patients with a body mass index of 40-60 kg/m2 scheduled for laparoscopic sleeve gastrectomy were randomly allocated into 2 groups. Patients in Group I (n=20 received a bilateral subcostal TAP block, and patients in Group II (n=20 received a bilateral subcostal and posterior TAP block. Pain intensity was assessed at rest and during coughing using the visual analog scale (VAS prior to and at various time points after TAP block (0 min, 30 min, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours. Morphine consumption over 24 hours and time to first morphine requirement were recorded. Results: There was no difference in VAS scores between groups. Morphine consumption was 6.78±5.95 mg in Group I, and 7.28±5.95 mg in Group II (p=0.795. Time to first morphine requirement was 267.22±303.84 min for Group I, and 207.80±209.81 min for Group II (p=0.154. Conclusions: Subcostal-posterior TAP block provided equivalent analgesia to subcostal TAP block alone following laparoscopic sleeve gastrectomy.

  2. CT-Guided Percutaneous Drainage of Infected Collections Due to Gastric Leak After Sleeve Gastrectomy for Morbid Obesity: Initial Experience

    International Nuclear Information System (INIS)

    Kelogrigoris, M.; Sotiropoulou, E.; Stathopoulos, K.; Georgiadou, V.; Philippousis, P.; Thanos, L.

    2011-01-01

    This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26–52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkage of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.

  3. Effects of sleeve gastrectomy in neonatally streptozotocin-induced diabetic rats.

    Directory of Open Access Journals (Sweden)

    Yan Wang

    Full Text Available BACKGROUND: Sleeve gastrectomy (SG has emerged recently as a stand-alone bariatric procedure to treat morbid obesity and enhance glucose homeostasis. The aim of the study was to evaluate its effects in neonatally streptozotocin (STZ-induced diabetic rats (n-STZ diabetic rats. METHODOLOGY AND PRINCIPAL FINDINGS: To induce diabetes, STZ (90 mg/kg was administered intraperitoneally to 2-day-old male pups. When 12 weeks old, diabetic rats were randomized into sleeve operation group (SLG, n = 6 and sham operation group (SOG, n = 6. Body weights were monitored weekly, and daily consumption of water and food were followed for eight consecutive weeks postoperatively. Serum glucose levels were measured periodically at the 4th and 8th week after surgery. Insulin, ghrelin, glucose-dependent insulinotropic polypeptide (GIP and Glucagon-like peptide-1 (GLP-1 levels were assayed at the end of the study. Our data showed that SLG rats exhibited significantly lower body weight gain in addition to reduced food and water intakes postoperatively compared to their sham-operation counterparts. However, resolution of diabetes was not observed in our study. Correspondingly, there were no significant differences between SOG rats and SLG rats in glucose metabolism-associated hormones, including insulin, GIP and GLP-1. In contrast, ghrelin level significantly decreased (P<0.01 in SLG group (58.01 ± 3.75 pg/ml after SG surgery compared to SOG group (76.36 ± 3.51 pg/ml. CONCLUSIONS: These observations strongly suggest that SG is effective in controlling body weight. However, SG did not achieve resolution or improvement of diabetes in n-STZ diabetic rats.

  4. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial.

    Science.gov (United States)

    Peterli, Ralph; Wölnerhanssen, Bettina Karin; Peters, Thomas; Vetter, Diana; Kröll, Dino; Borbély, Yves; Schultes, Bernd; Beglinger, Christoph; Drewe, Jürgen; Schiesser, Marc; Nett, Philipp; Bueter, Marco

    2018-01-16

    Sleeve gastrectomy is increasingly used in the treatment of morbid obesity, but its long-term outcome vs the standard Roux-en-Y gastric bypass procedure is unknown. To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss, changes in comorbidities, increase in quality of life, and adverse events. The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS), a 2-group randomized trial, was conducted from January 2007 until November 2011 (last follow-up in March 2017). Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers, 217 patients were enrolled and randomly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period. Patients were randomly assigned to undergo laparoscopic sleeve gastrectomy (n = 107) or laparoscopic Roux-en-Y gastric bypass (n = 110). The primary end point was weight loss, expressed as percentage excess body mass index (BMI) loss. Exploratory end points were changes in comorbidities and adverse events. Among the 217 patients (mean age, 45.5 years; 72% women; mean BMI, 43.9) 205 (94.5%) completed the trial. Excess BMI loss was not significantly different at 5 years: for sleeve gastrectomy, 61.1%, vs Roux-en-Y gastric bypass, 68.3% (absolute difference, -7.18%; 95% CI, -14.30% to -0.06%; P = .22 after adjustment for multiple comparisons). Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass (60.4%) than after sleeve gastrectomy (25.0%). Gastric reflux worsened (more symptoms or increase in therapy) more often after sleeve gastrectomy (31.8%) than after Roux-en-Y gastric bypass (6.3%). The number of patients with reoperations or interventions was 16/101 (15.8%) after sleeve gastrectomy and 23/104 (22.1%) after Roux-en-Y gastric bypass. Among patients with morbid obesity, there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux

  5. Enabling recruitment success in bariatric surgical trials: pilot phase of the By-Band-Sleeve study.

    Science.gov (United States)

    Paramasivan, S; Rogers, C A; Welbourn, R; Byrne, J P; Salter, N; Mahon, D; Noble, H; Kelly, J; Mazza, G; Whybrow, P; Andrews, R C; Wilson, C; Blazeby, J M; Donovan, J L

    2017-11-01

    Randomized controlled trials (RCTs) involving surgical procedures are challenging for recruitment and infrequent in the specialty of bariatrics. The pilot phase of the By-Band-Sleeve study (gastric bypass versus gastric band versus sleeve gastrectomy) provided the opportunity for an investigation of recruitment using a qualitative research integrated in trials (QuinteT) recruitment intervention (QRI). The QRI investigated recruitment in two centers in the pilot phase comparing bypass and banding, through the analysis of 12 in-depth staff interviews, 84 audio recordings of patient consultations, 19 non-participant observations of consultations and patient screening data. QRI findings were developed into a plan of action and fed back to centers to improve information provision and recruitment organization. Recruitment proved to be extremely difficult with only two patients recruited during the first 2 months. The pivotal issue in Center A was that an effective and established clinical service could not easily adapt to the needs of the RCT. There was little scope to present RCT details or ensure efficient eligibility assessment, and recruiters struggled to convey equipoise. Following presentation of QRI findings, recruitment in Center A increased from 9% in the first 2 months (2/22) to 40% (26/65) in the 4 months thereafter. Center B, commencing recruitment 3 months after Center A, learnt from the emerging issues in Center A and set up a special clinic for trial recruitment. The trial successfully completed pilot recruitment and progressed to the main phase across 11 centers. The QRI identified key issues that enabled the integration of the trial into the clinical setting. This contributed to successful recruitment in the By-Band-Sleeve trial-currently the largest in bariatric practice-and offers opportunities to optimize recruitment in other trials in bariatrics.

  6. Staple Line Reinforcement with Stitch in Laparoscopic Sleeve Gastrectomies. Is It Useful or Harmful?

    Science.gov (United States)

    Albanopoulos, Konstantinos; Tsamis, Dimitrios; Arapaki, Aggeliki; Kleidi, Eleftheria; Zografos, Georgios; Leandros, Emmanouil

    2015-07-01

    Reinforcement of the staple line in laparoscopic sleeve gastrectomy (LSG) is a practice that leads to less morbidity, but equivocal results have been reported in the literature. This is a prospective randomized study comparing two groups of patients who underwent LSG. In one group LSG was performed with a running absorbable suture placement at the staple line. In the other group the running suture was not placed. General data of the patients, as well as intraoperative and postoperative data, were gathered and statistically analyzed. Overall, 146 patients were subjected to LSG. In 84 patients a running suture was placed, and in 62 patients no suture was placed. No significant differences were found between the two groups in demographic data. No significant differences were found also in the intraoperative data, such as number of trocars, number and type of cartridges, drain placement, and operative time (45±21 versus 40±20 minutes, respectively; Prunning suture (9.5% versus 0.0%, respectively; P.05). After this randomized study, final conclusions about the efficacy of this running suture to the staple line cannot be made. To the contrary, problems seem to exist after such reinforcement of the staple line, such as hematomas. Dealing with possible leaks and hemorrhage of the staple line is also problematic after placement of the running suture.

  7. Stapling and Section of the Nasogastric Tube during Sleeve Gastrectomy: How to Prevent and Recover

    Directory of Open Access Journals (Sweden)

    A. Péquignot

    2011-07-01

    Full Text Available Bariatric surgery has become an integral part of morbid obesity treatment with well-defined indications. Some complications, specific or not, due to laparoscopic sleeve gastrectomy (LSG procedure have recently been described. We report a rare complication unpublished to date: a nasogastric section during great gastric curve stapling. A 44-year-old woman suffered of severe obesity (BMI 36.6 kg/m2 with failure of medical treatments for years. According to already published technique, a LSG was performed. Six hours postoperatively, a nurse removed the nasogastric tube according to the local protocol and the nasogastric tube was abnormally short, with staples at its extremity. Surgery was performed with peroperative endoscopy. In conclusion, this is the first publication of a nasogastric section during LSG. Therefore we report this case and propose a solution to prevent its occurrence. To avoid this kind of accident, we now systematically insert the nasogastric tube by mouth through a Guedel cannula. Then, to insert the calibrating bougie, we entirely withdraw the nasogastric tube.

  8. Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Mauro Montuori

    2017-01-01

    Full Text Available Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years’ experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%. All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6–34 days, SD ± 11.85. We recorded one death (16.67% due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26–83 days; SD ± 25.44. Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures.

  9. Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Alter the Gut-Brain Communication

    Directory of Open Access Journals (Sweden)

    L. A. Ballsmider

    2015-01-01

    Full Text Available This study investigated the anatomical integrity of vagal innervation of the gastrointestinal tract following vertical sleeve gastrectomy (VSG and Roux-en-Y gastric bypass (RYGB operations. The retrograde tracer fast blue (FB was injected into the stomach to label vagal neurons originating from nodose ganglion (NG and dorsal motor nucleus of the vagus (DMV. Microglia activation was determined by quantifying changes in the fluorescent staining of hindbrain sections against an ionizing calcium adapter binding molecule 1 (Iba1. Reorganization of vagal afferents in the hindbrain was studied by fluorescent staining against isolectin 4 (IB4. The density of Iba1- and IB4-immunoreactivity was analyzed using Nikon Elements software. There was no difference in the number of FB-labeled neurons located in NG and DMV between VSG and VSG-sham rats. RYGB, but not RYGB-sham rats, showed a dramatic reduction in number of FB-labeled neurons located in the NG and DMV. VSG increased, while the RYGB operation decreased, the density of vagal afferents in the nucleus tractus solitarius (NTS. The RYGB operation, but not the VSG procedure, significantly activated microglia in the NTS and DMV. Results of this study show that the RYGB, but not the VSG procedure, triggers microglia activation in vagal structures and remodels gut-brain communication.

  10. Port site hernia after laparoscopic sleeve gastrectomy: a retrospective cohort study of 352 patients.

    Science.gov (United States)

    Ece, Ilhan; Yilmaz, Huseyin; Alptekin, Husnu; Yormaz, Serdar; Colak, Bayram; Sahin, Mustafa

    2018-03-01

    Port site hernia (PSH) following laparoscopic procedures is a rare but serious complication. The aim of this study was to evaluate the rate of PSH after laparoscopic sleeve gastrectomy (LSG), and the efficacy of closure of the port site as a means of preventing PSH. A retrospective analysis was performed on 386 patients who underwent LSG between December 2009 and January 2015. 352 (91.2%) of the patient were followed up for at least 24 months. In the first 206 patients, the fascial layers of the trocar incisions were not closed, while in the next 146 cases, routine closure of the trocar sites was performed. The patients were reviewed in relation to demographics, comorbidities, complications, percentage of excess weight loss, and rates of PSH. The total cohort consisted of 220 female and 132 male patients with a mean age of 36.2 ± 12.3 years. Demographic data, initial BMI, and comorbidities were similar for the patients in both groups. The closure of the fascia was caused by the prolonged duration of the operation with no significant difference. The unclosed fascial defects were associated with a significantly increased incidence of PSH (1.3 vs. 3.9%, p port sites may result in a decreased PSH rate.

  11. Microcirculatory Improvement Induced by Laparoscopic Sleeve Gastrectomy Is Related to Insulin Sensitivity Retrieval.

    Science.gov (United States)

    Ministrini, Stefano; Fattori, Chiara; Ricci, Maria Anastasia; Bianconi, Vanessa; Paltriccia, Rita; Boni, Marcello; Paganelli, Maria Teresa; Vaudo, Gaetano; Lupattelli, Graziana; Pasqualini, Leonella

    2018-05-12

    Microvascular dysfunction is a potential factor explaining the association of obesity, insulin resistance, and vascular damage in morbidly obese subjects. The purpose of the study was to evaluate possible determinants of microcirculatory improvement 1 year after laparoscopic sleeve gastrectomy (LSG) intervention. Thirty-seven morbidly obese subjects eligible for bariatric surgery were included in the study. Post-occlusive reactive hyperemia (PORH) of the forearm skin was measured as area of hyperemia (AH) by laser-Doppler flowmetry before LSG and after a 1-year follow-up. After intervention, we observed a significant reduction in BMI, HOMA index, HbA1c, and a significant increase of AH in all patients after surgery; this variation was significant only in those patients having insulin resistance or prediabetes/diabetes. Although significant correlation between the increase of AH and the reduction of both BMI, HOMA index, and HbA1c was observed, BMI was the only independent predictor of AH variation after LSG at the linear regression analysis. Our study shows that LSG intervention is correlated with a significant improvement in the microvascular function of morbidly obese subjects; this improvement seems to be related to the baseline degree of insulin-resistance and to the retrieval of insulin-sensitivity post-intervention.

  12. Health-Related Fitness Improvements in Morbid Obese Patients After Laparoscopic Sleeve Gastrectomy: a Cohort Study.

    Science.gov (United States)

    Gallart-Aragón, Tania; Fernández-Lao, Carolina; Castro-Martín, Eduardo; Cantarero-Villanueva, Irene; Cózar-Ibáñez, Antonio; Arroyo-Morales, Manuel

    2017-05-01

    Laparoscopic sleeve gastrectomy (LSG) has demonstrated high long-term effectiveness and major advantages over other techniques. The objective of this study was to analyze changes in physical fitness parameters in morbidly obese patients during 6 months after LSG. We conducted a descriptive observational study with 6-month follow-up in 72 LSG patients, evaluating changes in body mass index (BMI), functional capacity (6-min walking test), hand grip strength (manual dynamometry), flexibility (fingertip-to-floor test), balance (Flamingo test), physical activity level (International Physical Activity Questionnaire, IPAQ), and perception of general physical fitness (International Fitness Scale [IFIS] questionnaire). The ANOVA revealed significant improvements in BMI, functional capacity, flexibility, balance, and physical activity level (P fitness in most cases. No significant changes were found in dominant hand (P = 0.676) or non-dominant hand (P = 0.222) dynamometry. General physical fitness was positively correlated with BMI and distance in the 6-min test, and was negatively correlated with fingertip-to-floor distance. Morbidly obese patients showed major improvements at 6 months after LSG in functional capacity, balance, mobility, and physical activity, with no change in grip strength. These improvements were related to a better self-perception of general physical fitness.

  13. Refinement of Perioperative Feeding in a Mouse Model of Vertical Sleeve Gastrectomy.

    Science.gov (United States)

    Doerning, Carolyn M; Burlingame, Lisa A; Lewis, Alfor G; Myronovych, Andriy; Seeley, Randy J; Lester, Patrick A

    2018-05-01

    Provision of liquid enteral nutrition (LEN) during the perioperative period is standard practice for rodents undergoing bariatric surgery, yet these diets are associated with several challenges, including coagulation of the liquid diet within the delivery system and decreased postoperative consumption. We investigated the use of a commercially available high-calorie dietary gel supplement (DG) as an alternative food source for mice during the perioperative period. C57BL/6J male mice were fed high-fat diet for 8 to 10 wk prior to surgery. The study groups were: vertical sleeve gastrectomy (VSG) +DG, VSG+LEN, sham surgery+DG, and sham+LEN. Food and water intakes, body weight, and body fat composition was monitored throughout the study. Mice that received DG lost significantly more weight preoperatively than those fed LEN. However, during the postoperative period, body weight, body fat composition, and water and caloric intake were similar among all experimental diet groups. Three mice in the VSG+LEN group were euthanized due to clinical illness during the course of the study. In summary, feeding a high-calorie DG to mice undergoing VSG surgery is a viable alternative to LEN, given that DG does not significantly affect the surgical model of weight loss or result in adverse clinical outcomes. We recommend additional metabolic characterization of DG supplementation to ensure that this novel diet does not confound specific research goals in the murine VSG model.

  14. Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development.

    Science.gov (United States)

    Spann, Redin A; Lawson, William J; Bidwell, Gene L; Zamarripa, C Austin; Maranon, Rodrigo O; Bandyopadhyay, Sibali; Taylor, Erin R; Reckelhoff, Jane F; Garrett, Michael R; Grayson, Bernadette E

    2018-01-31

    Bariatric surgery is increasingly employed to improve fertility and reduce obesity-related co-morbidities in obese women. Surgical weight loss not only improves the chance of conception but reduces the risk of pregnancy complications including pre-eclampsia, gestational diabetes, and macrosomia. However, bariatric procedures increase the incidence of intrauterine growth restriction (IUGR), fetal demise, thromboembolism, and other gestational disorders. Using our rodent model of vertical sleeve gastrectomy (VSG), we tested the hypothesis that VSG in diet-induced, obese dams would cause immune and placental structural abnormalities that may be responsible for fetal demise during pregnancy. VSG dams studied on gestational day (G) 19 had reduced circulating T-cell (CD3 + and CD8 + ) populations compared with lean or obese controls. Further, local interleukin (IL) 1β and IL 1 receptor antagonist ( il1rn ) cmRNA were increased in placenta of VSG dams. Placental barrier function was also affected, with increased transplacental permeability to small molecules, increased matrix metalloproteinase 9 expression, and increased apoptosis in VSG. Furthermore, we identified increased placental mTOR signaling that may contribute to preserving the body weight of the fetuses during gestation. These changes occurred in the absence of a macronutrient deficit or gestational hypertension in the VSG dams. In summary, previous VSG in dams may contribute to fetal demise by affecting maternal immune system activity and compromise placental integrity. © 2018 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.

  15. Contrasting Sleeve Gastrectomy with Lifestyle Modification Therapy in the Treatment of Polycystic Ovary Syndrome.

    Science.gov (United States)

    Wang, Kaijing; Jiang, Qixin; Zhi, Yunqing; Zhu, Zhe; Zhou, Zhuqing; Xie, Yanting; Yin, Xiaoqi; Lu, Aiguo

    2015-06-01

    To explore the feasibility of sleeve gastrectomy (SG) as a treatment for polycystic ovary syndrome (PCOS) and its potential to improve clinical efficacy in PCOS patients with symptoms of oligomenorrhea. Twenty-four obese patients with PCOS underwent laparoscopic SG. Simultaneously, 24 obese patients with PCOS received lifestyle modification therapy (LMT). Follow-ups were conducted at 3-6 months. Weight loss, menstruation, and improvements in hirsutism and metabolic symptoms were compared. In the SG group, 20 patients were restored to normal menstrual cycles and ovulation at 3-6 months after surgery. Their average androgen levels decreased significantly following surgery (P=.012). Conversely, only 6 patients in the LMT group were restored to normal menstrual cycles and ovulation after receiving 3 months of treatment. Their average preoperative and postoperative androgen levels showed a nonstatistically significant decrease (P>.05). Compared with the LMT group, the SG group showed more pronounced improvements in menstruation. Additionally, body mass and body mass index were significantly reduced in patients in the SG group 3 months after the surgeries, with maximum weight loss observed at approximately 6 months after surgery. Patients who received LMT showed a gradual weight reduction such that body mass decreased significantly after 3 months (Pweight loss results (Pweight loss and better improvements in clinical symptoms compared with LMT.

  16. Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps.

    Science.gov (United States)

    Špička, Petr

    2017-06-01

    Laparoscopic sleeve gastrectomy (LSG) is one of the most efficient bariatric interventions in morbidly obese patients. The most severe risk of this procedure seems to be the staple line leak, and the management of this complication can be very arduous. To share our experience in managing the staple line leak after LSG and to help to find the best procedure that should be preferred. In the 2010-2015 period we performed 223 LSG, with about 5 demonstrating severe complications - two patients with severe bleeding requiring revision surgery, and three patients with resection surface leak. We always primarily treated the staple line leak with a laparoscopic revision. Once the fistula did not spontaneously close after this treatment. A series of other methods were then indicated for this patient and only the sixth one resulted in the desirable therapeutic success. At first, our team opted for laparoscopic revision with drainage. The next procedure involved applying Ovesco and Boston clips. As a third method we performed abscess drainage through a nasobiliary tube inserted via gastroscopy. Due to failure we performed the second laparoscopic revision with staple line resuture, the next intervention was an open revision with fistula excision and suture, and finally we opted for the application of a self-expanding metallic stent, which proved to be definitely curative. Without any guidelines it is very difficult to determine the right procedure addressing the staple line leak after LSG. It depends mainly on the clinician's experience and is lengthy and often untraditional.

  17. Comparison of Early Results and Complications between Multi-and Single-Port Sleeve Gastrectomy: A Randomized Clinical Study

    Directory of Open Access Journals (Sweden)

    Seyed Vahid Hosseini

    2017-05-01

    Full Text Available Background: In recent years, laparoscopic sleeve gastrectomy (LSG has become more acceptable for obese patients. Single-port sleeve gastrectomy (SPSG is more popular since each abdominal incision carries the risk of bleeding, hernia, and internal organ injury as well as exponentially affecting cosmesis. This cross-sectional study aimed at comparing multi-port sleeve gastrectomy (MPSG and SPSG in terms of their early results and complications. Methods: Out of129 obese patients candidated for LSG, 102 patients were assigned to 2 groups of SPSG and MPSG. Complications and demographic data such as body mass index (BMI, age, gender, operation time, and hospital stay were measured. All surgeries were carried out between2013 and 2015 in Shiraz, Iran. Data analysis was performed using SPSS, version 16 for Windows (SPSS Inc., Chicago, IL. The continuous and categorical variables were compared using the Student t-test and the Chi-square test or the Fisher exact test, respectively. Results: The patients’ data from both groups were similar in terms of age, intraoperative and postoperative bleeding volume, and length of hospital stay. Mean BMI was 42.8±0.7 in the SPSG group and 45.3±1.2 in the MPSG group. Duration of surgery was significantly lower in the SPSG group (P<0.001. Only 1 patient from the SPSG group and 5 patients from the MPSG group had bleeding as an early complication. Conclusion: The differences in each complication between the groups were not statistically significant. SPSG seems to be safe and is the same as MPSG in terms of major postoperative complications. Trial Registration Number: IRCT201512229936N12

  18. Weight loss independent changes in adipose tissue macrophage and T cell populations after sleeve gastrectomy in mice

    Directory of Open Access Journals (Sweden)

    Henriette Frikke-Schmidt

    2017-04-01

    Full Text Available Objective: In addition to adipocytes, adipose tissue contains large numbers of immune cells. A wide range of evidence links the activity of these cells to regulation of adipocyte and systemic metabolic function. Bariatric surgery improves several aspects of metabolic derangements and at least some of these effects occur in a weight-loss independent manner. We sought to investigate the impact of vertical sleeve gastrectomy (VSG on adipose immune cell frequencies. Methods: We analyzed the frequencies of immune cells within distinct adipose tissue depots in obese mice that had VSG or sham surgery with a portion of the latter group pair-fed such that their body mass was matched to the VSG animals. Results: We demonstrate that VSG induced a shift in the epididymal adipose tissue leukocyte profile including increased frequencies of CD11c− macrophages, increased frequencies of T cells (CD4+, CD8+, and CD4−/CD8− T cells all increased, but a significantly decreased frequency of adipose tissue dendritic cells (ATDC that, despite the continued high fat feeding of the VSG group, dropped below control diet levels. Conclusions: These results indicate that VSG induces substantial changes in the immune populations residing in the adipose depots independent of weight loss. Author Video: Author Video Watch what authors say about their articles Keywords: Sleeve gastrectomy, Adipose tissue, Macrophages, T cells, Dendritic cells, Abbreviations: ATDC, adipose tissue dendritic cell, ATM, adipose tissue macrophage, eWAT, epididymal white adipose tissue, FFA, free fatty acids, HFS, high fat sham, iWAT, inguinal white adipose tissue, SVC, stromal vascular cells, VSG, vertical sleeve gastrectomy

  19. Vertical sleeve gastrectomy reduces blood pressure and hypothalamic endoplasmic reticulum stress in mice

    Directory of Open Access Journals (Sweden)

    Anne K. McGavigan

    2017-03-01

    Full Text Available Bariatric surgery, such as vertical sleeve gastrectomy (VSG, causes remarkable improvements in cardiometabolic health, including hypertension remission. However, the mechanisms responsible remain undefined and poorly studied. Therefore, we developed and validated the first murine model of VSG that recapitulates the blood pressure-lowering effect of VSG using gold-standard radiotelemetry technology. We used this model to investigate several potential mechanisms, including body mass, brain endoplasmic reticulum (ER stress signaling and brain inflammatory signaling, which are all critical contributors to the pathogenesis of obesity-associated hypertension. Mice fed on a high-fat diet underwent sham or VSG surgery and radiotelemeter implantation. Sham mice were fed ad libitum or were food restricted to match their body mass to VSG-operated mice to determine the role of body mass in the ability of VSG to lower blood pressure. Blood pressure was then measured in freely moving unstressed mice by radiotelemetry. VSG decreased energy intake, body mass and fat mass. Mean arterial blood pressure (MAP was reduced in VSG-operated mice compared with both sham-operated groups. VSG-induced reductions in MAP were accompanied by a body mass-independent decrease in hypothalamic ER stress, hypothalamic inflammation and sympathetic nervous system tone. Assessment of gut microbial populations revealed VSG-induced increases in the relative abundance of Gammaproteobacteria and Enterococcus, and decreases in Adlercreutzia. These results suggest that VSG reduces blood pressure, but this is only partly due to the reduction in body weight. VSG-induced reductions in blood pressure may be driven by a decrease in hypothalamic ER stress and inflammatory signaling, and shifts in gut microbial populations.

  20. A New Algorithm to Reduce the Incidence of Gastroesophageal Reflux Symptoms after Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Ece, Ilhan; Yilmaz, Huseyin; Acar, Fahrettin; Colak, Bayram; Yormaz, Serdar; Sahin, Mustafa

    2017-06-01

    Laparoscopic sleeve gastrectomy (LSG) is one of the most prefered treatment option for morbid obesity. However, the effects of LSG on gastroesophageal reflux disease (GERD) are controversial. Asymptomatic GERD and hiatal hernia (HH) is common in obese patients. Therefore, it is important to identify the high risk patients prior to surgery. This study aims to evaluate efficacy of cruroplasty for HH during LSG in morbidly obese patients using ambulatory pH monitoring (APM) results, and to investigate the patients' selection criteria for this procedure. This retrospective study includes outcomes of 59 patients who underwent LSG and HH repair according to our patient selection algorithm. Outcomes included preoperative GERD Health-Related Quality of Life (GERD-HRQL) questionnaire, APM results, percentage of postoperative excess weight loss, and total weight loss. For a total of 402 patients, APM was applied in 70 patients who had a positive score of GERD-HRQL, and 59 patients underwent LSG and concomitant HH repair who had a DeMeester score of 14.7% or above. There was no statistically significant difference in weight loss at 6 and 12-month follow-up. Two patients (3.3%) had symptoms of GERD at 12 months postoperatively, and only one (1.6%) patient required treatment of proton pump inhibitor for reflux. In the total cohort, 11 (2.7%) patients also evolved de novo GERD symptoms. This study confirm that careful attention to patient selection and surgical technique can reduce the symptoms of GERD at short-term. Routine bilateral crus exploration could be a major risk factor of postoperative GERD.

  1. Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair: an Unresolved Question.

    Science.gov (United States)

    Dakour Aridi, Hanaa; Asali, Mohammad; Fouani, Tarek; Alami, Ramzi S; Safadi, Bassem Y

    2017-11-01

    The effectiveness of the concomitant repair of hiatal hernia (HHR) during laparoscopic sleeve gastrectomy (LSG) in reducing gastroesophageal reflux disease (GERD) symptoms is still unclear. The aim of this study is to assess the effect of concomitant HHR on postoperative GERD symptoms in our patient population. A retrospective review of patients who underwent LSG with or without HHR between 2011and 2014 was performed. Pre- and postoperative GERD symptoms were assessed at different time intervals until a maximum of 2 years after the surgery. The study included 165 patients; 76 (46%) underwent LSG with concomitant HHR (group A) while the rest underwent only LSG (group B). Baseline GERD complaints were more prevalent in group A (61.8 vs 41.6%, p = 0.04), in which 44 patients (57.9%) had evidence of hiatal hernia on preoperative EGD. In the remaining 32 patients, it was diagnosed intraoperatively. GERD symptoms did not significantly differ between the two groups after years 1 and 2. GERD remission was observed in 21.3% of the 76 patients who underwent concomitant HHR (group A) and in 29.7% of those who did not (group B) while new-onset GERD symptoms were reported in 12 patients (41.4%) in group A and in 24 patients (46.2%) in group B. Routine HHR at the time of LSG does not show an improvement in GERD symptoms. More prospective studies are needed to clarify the role of the routine dissection, identification, and repair of concomitant hiatal hernia during LSG.

  2. Formal Nutritional Education Improves Weight Loss in Bariatric Patients Following Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Mangieri, Christopher Wesley; Strode, Matthew A

    2016-12-01

    Laparoscopic sleeve gastrectomy (LSG) is an increasingly performed procedure in the bariatric surgery armamentarium. This study evaluates our experience with LSG at Dwight D. Eisenhower Army Medical Center (DDEAMC) during the time period of 2008-2010. We found that the inclusion of formal nutritional education significantly increased our weight loss results following LSG. This is a retrospective review from our LSG caseload from 2008 to 2010. During that time, we performed 159 LSG. In our review, we performed comparative data of all operative years during 2008-2010 for up to 3 years postoperatively. Our main focus was in regard to weight loss as measured by percentage of excess body weight loss (%EWL), percentage of total weight loss (%TWL), and percentage of excess BMI loss (%EBL). We also evaluated the effect of LSG on diabetes mellitus (DM) and hypertension (HTN) postoperatively. We found an improvement in our %EWL, %TWL, and %EBL rates in our LSG cases following the inclusion of formal nutritional education. There was a mean increase in %EWL of 15 %, %TWL of 7 %, and %EBL of 21 %, which were statistically significant, that was present at all postoperative years of follow-up. We determined the only variable that changed in our bariatric program starting in 2010 was the inclusion of formal nutritional education. We also found a statistically significant improvement in resolution of HTN with the inclusion of formal nutritional education. The addition of formal nutritional education can enhance weight loss following bariatric surgery. We have shown a significant improvement in weight loss results following LSG with the implementation of formal nutritional education; this is the only study to our knowledge evaluating formal nutritional education and LSG.

  3. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Abdallah, Emad; Emile, Sameh Hany; Elfeki, Hossam; Fikry, Mohamed; Abdelshafy, Mahmoud; Elshobaky, Ayman; Elgendy, Hesham; Thabet, Waleed; Youssef, Mohamed; Elghadban, Hosam; Lotfy, Ahmed

    2017-07-01

    Postoperative cholelithiasis (CL) is a latent complication of bariatric surgery. The aim of this study was to evaluate the role of ursodeoxycholic acid (UDCA) in the prevention of CL after laparoscopic sleeve gastrectomy (LSG). This was a retrospective analysis of the prospectively collected data of patients with morbid obesity who underwent LSG. Patients were subdivided into two groups: Group I, which did not receive prophylactic treatment with UCDA after LSG; and Group II, which received UCDA therapy for 6 months after LSG. Patients' characteristics, operation duration, weight loss data, and incidence of CL at 6 and 12 months postoperatively were collected. A total of 406 patients (124 males, 282 females) with a mean age of 32.1 ± 9.4 years were included. The mean baseline body mass index (BMI) was 50.1 ± 8.3 kg/m 2 . Group I comprised 159 patients, and Group II comprised 247 patients. The two groups showed comparable demographics, % excess weight loss (EWL), and decrease in BMI at 6 and 12 months after LSG. Eight patients (5%) developed CL in Group I, whereas no patients in Group II did (P = 0.0005). Preoperative dyslipidemia and rapid loss of excess weight within the first 3 months after LSG were the risk factors that significantly predicted CL postoperatively. The use of UCDA effectively reduced the incidence of CL after LSG in patients with morbid obesity. Dyslipidemia and rapid EWL in the first 3 months after LSG significantly predisposed patients to postoperative CL.

  4. Sweet Eating Habit: Does This Affect the Results After Sleeve Gastrectomy?

    Science.gov (United States)

    Moser, Federico; Marconetto, Mariana; Gorodner, Verónica; Viscido, Germán; Piazzoni, Noel; Maldonado, Pablo; Rodriguez, Eugenia Loretani; Obeide, Lucio

    2016-04-01

    It is commonly believed that eating habits, specially the sweet eating habit, can predict results after bariatric surgery; for this reason, it is considered one of the selection criteria when deciding the surgical technique. However, there is not enough evidence of its impact on the results after sleeve gastrectomy (SG). To evaluate the relationship between the sweet eating habit and weight loss after SG. Cross-sectional retrospective study. Group A: nonobese subjects, and group B: patients who underwent SG and had ≥6 months follow-up. Demographics, anthropometrics, percentage excess weight loss (%EWL) at 6, 12, and 24 months, and eating habits before surgery were analyzed. Sweet eating consumption was classified as follows: mild, moderate, and severe. Uni- and bivariate logistic regression analysis according to each variable was performed. Between 2006 and 2011, 157 patients underwent SG at our institution; 36% were male, age 41 years old, and initial body mass index 46 kg/m(2). Mean %EWL at 6, 12, and 24 months was 66%, 77%, and 70%, respectively. Sweet eating consumption: Mild: 59%; Moderate: 38%; and Severe: 3%. No difference was found in sweet eating patterns among groups A and B; %EWL for mild, moderate, and severe sweet eaters at 6 months was 66 ± 16, 66 ± 14, and 65 ± 10, respectively (P = non-significant [NS]). The same analysis was made at 12 months: 76 ± 20, 79 ± 18, and 78 ± 11 (P = NS). At 24 months, only mild and moderate sweet eaters were available for comparison: 69 ± 23 and 73 ± 19, respectively (P = NS). Preliminary data suggested that preoperative sweet eating habit would not predict results after SG in terms of weight loss.

  5. Diet Change After Sleeve Gastrectomy Is More Effective for Weight Loss Than Surgery Only.

    Science.gov (United States)

    Rossell, Joana; González, Marta; Mestres, Núria; Pardina, Eva; Ricart-Jané, David; Peinado-Onsurbe, Julia; Baena-Fustegueras, Juan Antonio

    2017-10-01

    Bariatric surgery with or without diet change has become one of the most effective treatments for obesity. The objective of this study was to observe the effects of vertical sleeve gastrectomy (VSG) and diet change in Sprague-Dawley rats on both body and tissue weights. Eighteen rats were fed with a standard chow diet (SCD) (C group), and 36 rats were fed with a high-fat diet (HFD) (diet-induced obesity (DIO) group). After 8 weeks, the animals underwent VSG, sham surgery or no surgery (NS). After surgery, a third of the rats fed with the HFD changed to the SCD (DIO + C group). Body weight, food and energy intake were recorded daily during the experiment (12 weeks). Food efficiency (%) (FE) was determined from weekly weight gain and weekly kilocalorie consumed measurements. The DIO group had higher and significant weight gain than the C group at the time of surgery (p weight loss (WL) was observed in the DIO + C-VSG group, during the 4 weeks after surgery. Adipose tissues in the DIO + C-VSG group were drastically reduced and had a weight similar to those in the C-VSG group. VSG and the diet change combination led to a greater WL, which was maintained during the 4 weeks post-surgery, leading to a normalization of body weight. VSG and diet change also affected most of the tissues, not only adipose, showing a global change in whole body composition.

  6. Predictors of fat-free mass loss 1 year after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Guida, B; Cataldi, M; Busetto, L; Aiello, M L; Musella, M; Capone, D; Parolisi, S; Policastro, V; Ragozini, G; Belfiore, A

    2018-03-24

    Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric surgery interventions because of its safety and efficacy. Nevertheless, concerns have been raised on its detrimental effect on patient nutritional state that can ultimately lead to the loss of fat-free mass (FFM). There is interest in identifying predictors for the early identification of patients at risk of this highly unwanted adverse because they could benefit of nutritional preventive interventions. Therefore, we investigated whether anthropometric parameters, body composition or resting energy expenditure (REE) measured before surgery could predict FFM loss 1 year after LSG. Study design was retrospective observational. We retrieved data on body weight, BMI, body composition and REE before and 1 year after LSG from the medical files of 36 patients operated on by LSG at our institutions. Simple regression, the Oldham's method and multilevel analysis were used to identify predictors of FFM loss. Averaged percentage FFM loss 1 year after LSG was 17.0 ± 7.7% with significant differences between sexes (20.8 ± 6.6 in males and 12.2 ± 6.1% in females, p FFM loss was strongly predicted by pre-surgery FFM and this effect persisted also after correcting for the contribution of sex. High FFM values before surgery predict a more severe FFM loss after LSG. This factor could also account for the higher FFM loss in men than in women. Our finding could help in the early identification of patient requiring a nutritional support after LSG.

  7. Long-Term Results of Laparoscopic Sleeve Gastrectomy for Morbid Obesity: 5 to 8-Year Results.

    Science.gov (United States)

    Gadiot, Ralph P M; Biter, L Ulas; van Mil, Stefanie; Zengerink, Hans F; Apers, J; Mannaerts, Guido H H

    2017-01-01

    Although long-term results of sleeve gastrectomy (LSG) remain scarce in the literature, its popularity as a stand-alone procedure has accounted for a global increase in LSG performance. In this retrospective study, the authors present 5 to 8-year follow-up results in terms of weight loss, failure/revision rate, and comorbidity resolution from a single center. A prospectively maintained database was reviewed for patients who underwent LSG between 2007 and 2010. Data analysis on weight loss, comorbid conditions, revision surgery, and mortality was conducted. Median percentage excess BMI loss (%EBMIL) was 59.0, and 53.9 %, and median percentage total weight loss (%TWL) was 25.1, and 22.9 % at 5 and 8 years, respectively. Revision to gastric bypass due to insufficient weight loss or gastroesophageal reflux disease (GERD) was performed in 42 patients (15.2 %). Resolution of comorbid condition was achieved in 91 % of patients with obstructive sleep apnea syndrome (OSAS), 68 % of patients with type 2 diabetes (T2DM), 53 % of patients with hypertension, and 25 % of patients with dyslipedemia. Loss to follow-up rate was 45 % at 5 years, 28 % at 6 years, 23 % at 7 years, and 13 % at 8 years. This study adds to the currently available data confirming the LSG to be a safe and effective procedure at long term. Data from high-volume studies are needed to establish the definite role of the LSG in the spectrum of bariatric procedures.

  8. Weight Loss and Glycemic Control after Sleeve Gastrectomy: Results from a Middle Eastern Center of Excellence.

    Science.gov (United States)

    Al Khalifa, Khalid; Al Ansari, Ahmed; Showaiter, May

    2018-02-01

    Obesity and its associated metabolic disorders are strongly linked to both morbidity and mortality. Sleeve gastrectomy (SG) has been established as an effective means of weight loss for obese patients as well as a treatment for type 2 diabetes mellitus (T2DM). This study was designed to examine the short- and midterm outcomes of patients who underwent SG in a Middle Eastern Center of Excellence, a military training teaching hospital. The clinical outcomes of 59 patients with impaired glucose tolerance and T2DM who underwent SG between 2011 and 2014 with at least one and up to four years of follow-up were studied. Data were collected and compared, including the pre- and post-surgery measures of weight, body mass index, glycosylated hemoglobin (HbA1c), and fasting blood glucose. Complete remission was defined as a fasting blood glucose level ≤100 mg/dL, an HbA1c ≤6 mg/dL, without use of antidiabetic medications. All patients showed significant reduction in body mass index following SG. Tight glycemic control was achieved among both diabetic and prediabetic patients. In this study, 88.14 per cent of all patients (diabetic and prediabetic) achieved complete resolution from their impaired glucose tolerance and T2DM and maintained normal blood glucose and HbA1C levels from one to four years postoperatively. SG is beneficial both in terms of short- and midterm weight loss and glucose control in both diabetic and prediabetic obese patients.

  9. A Randomized Comparison Between Staple-Line Oversewing Versus No Reinforcement During Laparoscopic Vertical Sleeve Gastrectomy.

    Science.gov (United States)

    Taha, Osama; Abdelaal, Mahmoud; Talaat, Mohamed; Abozeid, Mohamed

    2018-01-01

    Varieties of intraoperative methods such as oversewing of staple lines or other reinforcement products are used for preventing the laparoscopic vertical sleeve gastrectomy (LSG) complications. The aim of this study is to evaluate the complication rates of the gastric stapling alone versus stapling with oversewing invagination of the staple line in the LSG. This is a single-center randomized study, Patients were randomized to two groups, 200 patients underwent LSG without reinforcement of the staple line and 200 patients underwent LSG with oversewing of the staple line. All patients were followed up for 1 year. The data collected prospectively for statistical analysis included demographics, BMI, preoperative comorbidities, operative time, complications, and hospital stay. The overall mean operative age was 33.7 ± 9.4 years and mean BMI was 42.4 ± 4.3 kg/m 2 . Patient baseline characteristics (age, gender, weight, and BMI) and comorbidities were generally a nonsignificant different between the treatment arms. Surgical time was shorter in patients of the nonreinforced group (44.3 ± vs 51.3 ± 4.3 min; p < 0.01) with lower %EWL (73 ± 13.8 vs 80.7 ± 13.6%, p < 0.01). One patient in the nonreinforced group was complicated by gastric leak. The staple-line bleeding rate was significantly lower in patients underwent oversewing of the staple line during LSG (p < 0.05). Oversewing of the staple line during LSG is a nonexpansive and easy method to decrease the incidence and severity of the postoperative bleeding. However, it is time-consuming and should be performed by experienced surgeons to avoid the complications which may occur secondary to the seroserotomy suturing.

  10. Comparison of two specimen retrieval techniques in laparoscopic sleeve gastrectomy: what is the role of endobag?

    Science.gov (United States)

    Shoar, Saeed; Aboutaleb, Shereen; Karem, Mohsen; Bashah, Moataz M; AlKuwari, Mohamed; Sargsyan, Davit; Saber, Alan A

    2017-12-01

    Laparoscopic sleeve gastrectomy (LSG) has become a popular stand-alone treatment for morbid obesity. However, removal of the gastric specimen could be a challenging step due to its large size relative to the width of the trocar site. We aimed to compare a simplified retrieval technique for extraction of the gastric specimen without an endobag with conventionally performed specimen retrieval using an endobag. A case-control study was conducted recruiting patients undergoing LSG. Patient's demographics, preoperative characteristics, intra-operative, and postoperative variables were compared between the two groups according to the technique of gastric specimen removal. A total of 193 patients (60.6% female) were enrolled into case (n = 100) and control groups (n = 93). Mean ± SD age and BMI of patients were 35.64 ± 11.84 years and 47.28 ± 8.22 Kg/m 2 , respectively with no significant difference between groups. Median (25th, 75th inter-quartile), extraction time was significantly reduced in the non-endobag group compared to the endobag group (3.5 [2.5-4.5] min vs. 6.5 [3.4-8.2] min, p = 0.03).Patients of both groups had similar intra-operative and trocar site complications (hernia and wound infection) (3% for endobag group and 3.3 % for non-endobag group). The median (25-75% [IQR]) LOS was also comparable between endobag and non-endobag patients (3[2-3] vs. 3[2-4] days, p = 0.84). No difference was observed between the two groups for weight loss and comorbidity resolution. Non-endobag technique for gastric specimen retrieval is safe and feasible with substantial saving in operative time and comparable intra-operative and postoperative outcomes to the conventional retrieval technique.

  11. Routine intraoperative leak testing for sleeve gastrectomy: is the leak test full of hot air?

    Science.gov (United States)

    Bingham, Jason; Lallemand, Michael; Barron, Morgan; Kuckelman, John; Carter, Preston; Blair, Kelly; Martin, Matthew

    2016-05-01

    Staple line leak after sleeve gastrectomy (SG) is a rare but dreaded complication with a reported incidence of 0% to 8%. Many surgeons routinely test the staple line with an intraoperative leak test (IOLT), but there is little evidence to validate this practice. In fact, there is a theoretical concern that the leak test may weaken the staple line and increase the risk of a postop leak. Retrospective review of all SGs performed over a 7-year period was conducted. Cases were grouped by whether an IOLT was performed, and compared for the incidence of postop staple line leaks. The ability of the IOLT for identifying a staple line defect and for predicting a postoperative leak was analyzed. Five hundred forty-two SGs were performed between 2007 and 2014. Thirteen patients (2.4%) developed a postop staple line leak. The majority of patients (n = 494, 91%) received an IOLT, including all 13 patients (100%) who developed a subsequent clinical leak. There were no (0%) positive IOLTs and no additional interventions were performed based on the IOLT. The IOLT sensitivity and positive predictive value were both 0%. There was a trend, although not significant, to increase leak rates when a routine IOLT was performed vs no routine IOLT (2.6% vs 0%, P = .6). The performance of routine IOLT after SG provided no actionable information, and was negative in all patients who developed a postoperative leak. The routine use of an IOLT did not reduce the incidence of postop leak, and in fact was associated with a higher leak rate after SG. Published by Elsevier Inc.

  12. Preoperative Detection of Sarcopenic Obesity Helps to Predict the Occurrence of Gastric Leak After Sleeve Gastrectomy.

    Science.gov (United States)

    Gaillard, Martin; Tranchart, Hadrien; Maitre, Sophie; Perlemuter, Gabriel; Lainas, Panagiotis; Dagher, Ibrahim

    2018-03-02

    Sleeve gastrectomy (SG) has become the primary procedure for many bariatric teams and staple-line leak represents its most feared complication. Sarcopenic obesity combines the risks of obesity and depleted lean mass leading possibly to an inferior surgical outcome after abdominal surgery. The aim of this study was to evaluate the existence of a potential link between radiologically determined sarcopenic obesity and staple-line leak risk after SG. A retrospective analysis of a prospective database was performed in consecutive patients undergoing SG as primary procedure. Total psoas muscles (TPA) and total visible muscles (TMA) areas were measured on a preoperative computed tomography (CT). Sarcopenia was defined as lowest tertile of skeletal muscular mass indexes (muscular areas over square of height) in each gender (using TPA or TMA). Multivariate analysis was performed to determine preoperative risk factors for staple-line leak. During the study period, 205 patients were included in the analysis. Median BMI was 40.8 kg/m 2 (34.2-49.6), and 9 patients (4.4%) presented a gastric leak. The sex-specific cut-offs for skeletal muscular mass index according to TPA were 8.2 cm 2 /m 2 for men and 6.08 cm 2 /m 2 for women. After multivariate analysis, preoperative weight (OR = 1043) and sarcopenia (TPA) (OR = 5204) were independent predictive factors for gastric leak. The present series suggests that CT scan-determined sarcopenic obesity is associated with increased risk of gastric leak after SG. This preoperatively radiological examination would be a useful clinical tool to tailor patient management according to gastric leak risk.

  13. Influence of Sleeve Gastrectomy on NASH and Type 2 Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    W. K. Karcz

    2011-01-01

    Full Text Available Background. Nonalcoholic fatty liver disease is present in up to 85% of adipose patients and may proceed to nonalcoholic steatohepatitis (NASH. With insulin resistance and obesity being the main risk factors for NASH, the effect of isolated sleeve gastrectomy (ISG on these parameters was examined. Methods. 236 patients underwent ISG with intraoperative liver biopsy from December 2002 to September 2009. Besides demographic data, pre-operative weight/BMI, HbA1c, AST, ALT, triglycerides, HDL and LDL levels were determined. Results. A significant correlation of NASH with higher HbA1c, AST and ALT and lower levels for HDL was observed (P<.05, <.0001, <.0001, <.01, resp.. Overall BMI decreased from 45.0 ± 6.8 to 29.7 ± 6.5 and 31.6 ± 4.4 kg/m2 at 1 and 3 years. An impaired weight loss was demonstrated for patients with NASH and patients with elevated HbA1c (plateau 28.08 kg/m2 versus 29.79 kg/m2 and 32.30 kg/m2 versus 28.79 kg/m2, resp.. Regarding NASH, a significant improvement of AST, ALT, triglyceride and HDL levels was shown (P<.0001 for all. A resolution of elevated HbA1c was observed in 21 of 23 patients. Summary. NASH patients showed a significant loss of body weight and amelioration of NASH status. ISG can be successfully performed in these patients and should be recommended for this subgroup.

  14. Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy.

    Science.gov (United States)

    Goitein, David; Sakran, Nasser; Rayman, Shlomi; Szold, Amir; Goitein, Orly; Raziel, Asnat

    2017-02-01

    Hiatal hernia (HH) is common in the bariatric population. Its presence imposes various degrees of difficulty in performing laparoscopic sleeve gastrectomy (LSG). Preoperative upper gastrointestinal evaluation consists of fluoroscopic and or endoscopic studies OBJECTIVES: To evaluate the efficacy of routine, preoperative barium swallow in identifying HH in patients undergoing LSG, and determine if such foreknowledge changes operative and immediate postoperative course regarding operative time, intraoperative adverse events, and length of hospital stay (LOS). In addition, to quantify HH prevalence in these patients and correlate preoperative patient characteristics with its presence. High-volume bariatric practice in a private hospital in Israel METHODS: Retrospective analysis of prospectively collected data between October 2010 and March 2015: anthropometrics, co-morbidities, previous barium swallow, preoperative HH workup (type and result), operative and immediate postoperative course. Primary LSG was performed in 2417 patients. The overall prevalence of HH was 7.3%. Preoperative diagnosis of gastroesophageal reflux disease and female gender were independent risk factors for HH presence. Operative times were significantly longer when HH was concomitantly repaired but "foreknowledge" thereof did not assist in shortening this time. Looking for an HH that was suggested in preoperative upper gastrointestinal evaluation slightly prolonged surgery. LOS was not changed in a significant fashion by HH presence and repair, whether suspected or incidentally found. Routine, pre-LSG barium swallow does not seem to offer an advantage over selective intraoperative hiatal exploration, in the discovery and management of HH. Conversely, when preoperative workup yields a false-positive result, surgery is slightly prolonged. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  15. Age is not associated with increased surgical complications in patients after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Jędrzejewski, Emil; Liszka, Maciej; Maciejewski, Marcin; Kowalewski, Piotr K; Walędziak, Maciej; Paśnik, Krzysztof; Janik, Michał R

    2018-03-01

    Age is considered as a risk factor in bariatric surgery. The observation was made on the basis of results from studies where patients underwent different type of surgery, but laparoscopic sleeve gastrectomy (LSG) was not among them. It is necessary to reevaluate the association of age with adverse events in the group of patients after LSG. To investigate the association of age with surgery-related adverse events in patients after LSG. Retrospective analysis of medical data was performed. The study involved 345 patients who underwent LSG in our institution between January 2013 and December 2014. The patients were subdivided by age into four groups according to quartiles. In 30-day follow-up adverse events were evaluated. We considered the presence of the following events as the endpoint of our study: death, medical events and surgical events. In general, we observed adverse events in 36 (10.4%) patients. The mortality rate in our study was 0.59%. Nineteen events were surgical and 18 medical. In 1 patient a surgical event was associated with a medical event. Bleeding was the most common surgical event and was observed in 17 (4.9%) cases. Age was not associated with surgical events (OR = 1.032, 95% CI: 0.991-1.075, p = 0.33) or medical events (OR = 0.997, 95% CI: 0.956-1.039, p = 0.89). The LSG is a safe bariatric procedure with low mortality. Bleeding is the most frequent surgical complication. Our findings suggest that age is not associated with increased risk of surgical or medical adverse events after LSG.

  16. Sleeve Gastrectomy: Correlation of Long-Term Results with Remnant Morphology and Eating Disorders.

    Science.gov (United States)

    Tassinari, Daniele; Berta, Rossana D; Nannipieri, Monica; Giusti, Patrizia; Di Paolo, Luca; Guarino, Daniela; Anselmino, Marco

    2017-11-01

    Remnant dimension is considered one of the crucial elements determining the success of sleeve gastrectomy (SG), and dilation of the gastric fundus is often believed to be the main cause of failure. The main outcome of this study is to find correlations between remnant morphology in the immediate post-operative stage, its dilation in years, and the long-term results. The second purpose aims to correlate preoperative eating disorders, taste alteration, hunger perception, and early satiety with post-SG results. Remnant morphology was evaluated, in the immediate post-operative stage and over the years (≥2 years), through X-ray of the oesophagus-stomach-duodenum calculating the surface in anteroposterior (AP) and right anterior oblique projection (RAO). Presurgery diagnosis of eating disorders and their evaluation through "Eating Disorder Inventory-3" (EDI3) during follow-up were performed. Change in taste perception, sense of appetite, and early satiety were evaluated. Patients were divided into two groups: "failed SGs (EWL50%). There were a total of 50 patients (37 F, 13 M), with mean age 52 years, preoperative weight 131 ± 21.8 kg, and BMI 47.4 ± 6.8 kg/m 2 . Post-operative remnant mean dimensions overlapped between the two groups. On a long-term basis, an increase of 57.2 and 48.4% was documented in the AP and RAO areas respectively. In "failed" SGs, dilation was significantly superior to "efficient" SGs (AP area 70.2 vs 46.1%; RAO area 59.3 vs 39%; body width 102% vs 41.7%). Preoperative eating disorders were more present in efficient SGs than in failed SGs with the exception of sweet eating. There were no significant changes to taste perception during follow-up. Fifty-two percent of efficient SGs vs 26% of failed SGs reported a persistent lack of sense of hunger; similarly, 92.5 vs 78% declared the persistence of a sense of early satiety. The two groups did not statistically differ as far as all the variables of the EDI3 are concerned. On a long

  17. Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Berna Dogan

    2016-01-01

    Full Text Available Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG. Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40 who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT, total macular volume (TMV, and retinal ganglion cell layer (RGCL were measured by spectral-domain optical coherence tomography (SD-OCT. Subfoveal choroidal thickness (SFCT was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT. Results. The mean CMT was 237.4±24.5 μm, 239.3±24.1 μm, and 240.4±24.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean TMV was 9.88±0.52 mm3, 9.96±0.56 mm3, and 9.99±0.56 mm3 preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean RGCL was 81.2±6.5 μm, 82.7±6.6 μm, and 82.9±6.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean SFCT was 309.8±71.8 μm, 331.0±81.4 μm, and 352.7±81.4 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (p=0.34, disc area (p=0.64, vertical cup/disc ratio (p=0.39, cup volume (p=0.08, or retinal nerve fiber layer (p=0.90. Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery.

  18. Evaluation of Nutritional Status Post Laparoscopic Sleeve Gastrectomy-5-Year Outcomes.

    Science.gov (United States)

    Al-Mutawa, Aliaa; Al-Sabah, Salman; Anderson, Alfred Kojo; Al-Mutawa, Mohammad

    2017-12-01

    Obesity is considered a public health problem and has led to advancements in bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) had become the most performed procedure worldwide; however, its consequences on nutritional status in the short and long term are of concern. A retrospective analysis of medical records and bariatric database of patients who underwent LSG from October 2008-September 2015 at Al-Amiri Hospital, Kuwait, was performed. Data regarding nutritional status along with demographic data were collected over a 5-year follow-up period. One thousand seven hundred ninety-three patients comprising of 74% females and 26% males were included. The greatest % total body weight loss (%TBWL) was at 18 months post-LSG (33%), corresponding to a % excess weight loss (%EWL) of 73.8%. With regard to nutritional status, vitamin B1 showed a significant drop at 3-5 years post-op in comparison to pre-op value, but stayed within the normal range throughout the study. Red blood cells count, hemoglobin, and hematocrit also showed a significant drop starting from 6 months post-op until the fifth year of follow-up. On the other hand, vitamins B6 and B12 showed a significant increase at 6 months post-op and decreased afterwards, but did not reach pre-op values. Vitamin D also showed a significant increase throughout the study period from deficient value at the pre-op time, but remained insufficient. Albumin, transferrin, folate, ferritin, iron, and vitamin B2 showed no significant changes at 5 years post-LSG compared to pre-op values. Little is known about the nutritional status and optimal nutritional care plan post-LSG, especially in the longer term. Nutritional deficiencies were prevalent prior and post-LSG. Some of the nutritional parameters improved and even reached the abnormal high level post-LSG. These observations highlight the importance of pre- and post-operative nutritional assessment and tailored supplementation to ensure optimal nutritional status.

  19. A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy.

    Science.gov (United States)

    Pucci, Andrea; Cheung, Wui Hang; Jones, Jenny; Manning, Sean; Kingett, Helen; Adamo, Marco; Elkalaawy, Mohamed; Jenkinson, Andrew; Finer, Nicholas; Doyle, Jacqueline; Hashemi, Majid; Batterham, Rachel L

    2015-01-01

    Sleeve gastrectomy (SG) is the second most commonly performed bariatric procedure worldwide. Altered circulating gut hormones have been suggested to contribute post-operatively to appetite suppression, decreased caloric intake and weight reduction. In the present study, we report a 22-year-old woman who underwent laparoscopic SG for obesity (BMI 46 kg/m(2)). Post-operatively, she reported marked appetite reduction, which resulted in excessive weight loss (1-year post-SG: BMI 22 kg/m(2), weight loss 52%, >99th centile of 1-year percentage of weight loss from 453 SG patients). Gastrointestinal (GI) imaging, GI physiology/motility studies and endoscopy revealed no anatomical cause for her symptoms, and psychological assessments excluded an eating disorder. Despite nutritional supplements and anti-emetics, her weight loss continued (BMI 19 kg/m(2)), and she required nasogastric feeding. A random gut hormone assessment revealed high plasma peptide YY (PYY) levels. She underwent a 3 h meal study following an overnight fast to assess her subjective appetite and circulating gut hormone levels. Her fasted nausea scores were high, with low hunger, and these worsened with nutrient ingestion. Compared to ten other post-SG female patients, her fasted circulating PYY and nutrient-stimulated PYY and active glucagon-like peptide 1 (GLP1) levels were markedly elevated. Octreotide treatment was associated with suppressed circulating PYY and GLP1 levels, increased appetite, increased caloric intake and weight gain (BMI 22 kg/m(2) after 6 months). The present case highlights the value of measuring gut hormones in patients following bariatric surgery who present with anorexia and excessive weight loss and suggests that octreotide treatment can produce symptomatic relief and weight regain in this setting. Roux-en-Y gastric bypass and SG produce marked sustained weight reduction. However, there is a marked individual variability in this reduction, and post-operative weight loss

  20. Achalasia: A case report on its effect during surgical decision making for laparoscopic sleeve gastrectomy in the young morbidly obese patient

    Directory of Open Access Journals (Sweden)

    Rodolfo J. Oviedo, MD, FACS

    2016-01-01

    Conclusion: The patient has already undergone a POEM procedure, which was chosen to maintain the gastric fundus, cardia, and gastroesophageal junction (GEJ architecture as opposed to a LHM with Dor fundoplication, which would have altered the anatomy, thus making a concomitant laparoscopic sleeve gastrectomy an unfeasible option.

  1. Prevalence of Chronic Gastritis or Helicobacter pylori Infection in Adolescent Sleeve Gastrectomy Patients Does Not Correlate with Symptoms or Surgical Outcomes.

    Science.gov (United States)

    Franklin, Ashanti L; Koeck, Emily S; Hamrick, Miller C; Qureshi, Faisal G; Nadler, Evan P

    2015-08-01

    In adults undergoing gastric bypass surgery, it is routine practice to perform pre-operative testing for Helicobacter pylori infection. Evidence suggests that infection impairs anastomotic healing and contributes to complications. There currently are no data for adolescents undergoing bariatric procedures. Despite few patients with pre-operative symptoms, we noted occasional patients with H. pylori detected after sleeve gastrectomy. We reviewed our experience with our adolescent sleeve gastrectomy cohort to determine the prevalence of H. pylori infection, its predictive factors, and association with outcomes. We hypothesized that H. pylori infection would be associated with pre-operative symptoms, but not surgical outcomes. All patients undergoing sleeve gastrectomy at our hospital were included. We conducted a chart review to determine pre- or post-operative symptoms of gastroesophageal reflux disease GERD or gastritis, operative complications, and long-term anti-reflux therapy after surgery. Pathology reports were reviewed for evidence of gastritis and H. pylori infection. 78 adolescents had laparoscopic sleeve gastrectomy from January 2010 through July 2014. The prevalence of chronic gastritis was 44.9% (35/78) and 11.4% of those patients had H. pylori (4/35). Only one patient with H. pylori had pre-operative symptoms, and only 25.7% (9/35) of patients with pathology-proven gastritis had symptoms. One staple line leak occurred but this patient did not have H. pylori or gastritis. Mean patient follow-up was 10 (3-26) mos. There is a moderate prevalence of gastritis among adolescents undergoing sleeve gastrectomy, but only a small number of these patients had H. pylori infection. Neither the presence of chronic gastritis nor H. pylori infection correlated with symptoms or outcomes. Thus, in the absence of predictive symptomology or adverse outcome in those who are infected, we advocate for continued routine pathologic evaluation without the required need for pre

  2. Change in levels of C-reactive protein (CRP) and serum cortisol in morbidly obese patients after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Oller, Inmaculada; Galindo, Isabel; Llavero, Carolina; Arroyo, Antonio; Calero, Alicia; Diez, María; Zubiaga, Lorea; Calpena, Rafael

    2013-06-01

    C-Reactive protein (CRP) has been associated with the macro- and microvascular effects of hypertension and diabetes mellitus. Referring to serum cortisol, it has been proposed to contribute to the pathogenesis of metabolic syndrome, and it has been demonstrated that weight loss normalizes cortisol levels and improves insulin resistance. The aims of this study were to analyze CRP and cortisol levels pre- and postoperatively in morbidly obese patients undergoing a laparoscopic sleeve gastrectomy and to correlate them with weight loss and parameters associated with cardiovascular risk. A prospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between October 2007 and May 2011 was performed. A total of 40 patients were included in the study. CRP levels decreased significantly 12 months after surgery (median reduction of 8.9 mg/l; p = 0.001). Serum cortisol levels decreased significantly 6 months after surgery (median reduction of 34.9 μg/dl; p = 0.001). CRP values reached the normal range (cortisol, a significant association was observed with the cardiovascular risk predictor (triglyceride/high-density lipoprotein cholesterol ratio) from the 6th month after surgery onward (Pearson correlation coefficient, 0.559; p = 0.008). CRP levels are increased preoperatively and in the postoperative course up to 1 year after surgery. Serum cortisol levels remain elevated until the 6th month after surgery. From this moment onward, serum cortisol is associated with the cardiovascular risk predictor reflecting the cardiovascular risk decreasement during the weight loss.

  3. Pre-operative and early post-operative factors associated with surgical site infection after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Oller, Inmaculada; Llavero, Carolina; Arroyo, Antonio; Muñoz, Jose Luis; Calero, Alicia; Diez, María; Zubiaga, Lorea; Calpena, Rafael

    2013-08-01

    Surgical procedures on obese patients are expected to have a high incidence of surgical site infection (SSI). The identification of pre-operative or early post-operative risk factors for SSI may help the surgeon to identify subjects in risk and adequately optimize their status. We conducted a study of the association of comorbidities and pre- and post-operative analytical variables with SSI following laparoscopic sleeve gastrectomy for the treatment of morbid obesity. We performed a prospective study of all morbidly obese patients undergoing laparoscopic sleeve gastrectomy as a bariatric procedure between 2007 and 2011. An association of clinical and analytical variables with SSI was investigated. The study included 40 patients with a mean pre-operative body mass index (BMI) of 51.2±7.9 kg/m(2). Surgical site infections appeared in three patients (7.5%), of whom two had an intra-abdominal abscess located in the left hypochondrium and the third had a superficial incisional SSI. Pre-operatively, a BMI >45 kg/m(2) (OR 8.7; p=0.008), restrictive disorders identified by pulmonary function tests (OR 10.0; p=0.012), a serum total protein concentration 30 mcg/dL (OR 13.0; p=0.003), and a mean corpuscular volume (MCV) operative SSI. Post-operatively, a serum glucose >128 mg/dL (OR 4.7; p=0.012) and hemoglobin operative anemia and hyperglycemia as risk factors for SSI. In these situations, the surgeon must be aware of and seek to control these risk factors.

  4. Banding the Sleeve Improves Weight Loss in Midterm Follow-up.

    Science.gov (United States)

    Fink, Jodok M; Hoffmann, Natalie; Kuesters, Simon; Seifert, Gabriel; Laessle, Claudia; Glatz, Torben; Hopt, Ulrich T; Konrad Karcz, W; Marjanovic, Goran

    2017-04-01

    Laparoscopic sleeve gastrectomy (LSG) can achieve excellent weight loss, yet sleeve dilatation with concomitant weight regain proves to be a relevant issue. Hence, additional restriction might improve results after LSG. In a retrospective matched-pair analysis, 42 patients who underwent banded LSG (BLSG) using a MiniMizer® ring between January 2012 and October 2014 were analysed regarding weight loss, complications and comorbidity. Median follow-up was 3 years. Forty-two patients who had undergone conventional LSG were selected as matched pairs. Mean preoperative BMI was 54.93 ± 7.42 kg/m 2 for BLSG and 53.46 ± 6.69 kg/m 2 for LSG (Mann-Whitney P = 0.540). Total weight loss (%TWL) was significantly greater in the BLSG group 3 years after surgery (BLSG 38.22% ± 7.26; n = 26 vs. LSG 32.69 ± 9.47; n = 26; P = 0.0154). Ring placement had no relevant impact on new-onset reflux (Fisher's exact test P = 1.0) but a tendency towards reflux improvement when reflux pre-existed (odds ratio 1.96). The major side effect of ring implantation was regurgitation with over 44% of patients presenting with regurgitation >1 per week (Fisher's exact test P = 0.0019, odds ratio 18.07). BLSG is a safe procedure showing similar comorbidity to conventional LSG. However, BLSG leads to a higher rate of postoperative regurgitation. Weight loss is significantly improved 3 years after surgery. Hence, additional ring implantation might be an option for increased restriction in LSG surgery.

  5. [Nutrition management in obese patients with type 2 diabetes mellitus after laparoscopic sleeve gastrectomy].

    Science.gov (United States)

    Tang, Weihong; Chen, Yuhua; Pan, Meizhen; Chen, Lihua; Zhang, Lele; Wang, Tingfeng; Zhang, Xiong; Zhang, Peng; Zheng, Chengzhu; Yu, Bo

    2017-04-25

    To explore the value of nutrition management in obese patients with type 2 diabetes mellitus(T2DM) after laparoscopic sleeve gastrectomy(LSG). Clinical data of 22 obese T2DM patients undergoing LSG from March 2013 to July 2015 in Fudan University Pudong Medical Center were collected. All the patients strictly followed the specialized instruction by nutritionists: diabetic and low calorie diet 3347.2 to 5020.8 kJ (800 to 1200 kcal) per day before the operation; low calorie liquid diet 2510.4 kJ(600 kcal) per day before operation for promoting gastric emptying; fasting diet before postoperative ventilation; clear liquid diet 1673.6 to 2510.4 kJ (400 to 600 kcal) per day after postoperative ventilation (liquid intake >2000 ml); low fat liquid diet 2928.8 to 3765.6 kJ (700 to 900 kcal) per day (protein 60 g per day at least, 2000 ml liquid) 2 weeks after the operation; semi-liquid diet 1 month after operation and gradually normal diet. All the 22 patients were followed up at 1 week, 1, 3, 6 months after operation on time. Changes of body weight, waist circumference, hip circumference, body mass index(BMI), blood glucose indexes induding fasting blood glucose(FBG), 2-hour postparandial blood glucose(PBG), fasting C-peptide, 2-hour postprandial C-peptide, fasting serum inculin(FINS), 2-hour postprandial inculin(INS), HbAlc, blood pressure and blood lipid indexes were observed and analyzed before and 1 week, 1, 3, 6 months after operation. The average age of 22 patients (10 men and 12 women) was 38.6 years (18 to 66 years). The duration of diabetes varied from 1 month to 15 years. Comorbidity included 12 patients of high blood pressure, 14 of fatty liver, 1 of coronary heart disease, 1 of gout, 1 of chronic thyroiditis and 1 of menstrual disorder. LSG was performed successfully in all the patients and no severe complications and transference to laparotomy occurred. As compared to pre-operation, at 6 months after operation, the average body weight decreased from (103.9±20

  6. SPIDER ® sleeve gastrectomy--a new concept in single-trocar bariatric surgery: initial experience and technical details.

    Science.gov (United States)

    Noel, P; Nedelcu, M; Gagner, M

    2014-04-01

    Single port instrument delivery extended reach (SPIDER(®)) surgical system is a revolutionary surgical platform that allows triangulation of the surgical instruments while eliminating the crossing of instruments, the problematic characteristic of single access laparoscopic surgery. The purpose of this study was to analyze our initial experience with SPIDER(®) sleeve gastrectomy and to present the technical details of this new minimally invasive approach, performed in ten patients at the La Casamance Private Hospital between November 2012 and April 2013. All patients were reviewed at scheduled post-operative consultations at 1, 3 and 6 months. In addition to clinical examination, the post-operative consultation at one month also included a satisfaction survey using the Moorehead-Ardelt questionnaire. An initial series of ten sleeve gastrectomies were performed in female patients with a mean age of 41.5 years (range: 2-52). The mean BMI was 40.11 (range: 37.25-44.3). The intervention was performed through a single trocar in all patients with no "conversion" to classic laparoscopy or open surgery. The mean operative time was 61 ± 15.22 minutes (SD=standard deviation) (range: 43-96 min). The mean BMI at one month was 35.5 (SD:± 3.58, SEM: ± 1.13) (SEM=standard error of mean) with an average percentage of excess weight loss (%EWL) of 32.9% (SD:± 8.56%, SEM:± 2.71%). The mean BMI at three months was 32.4 (SD: ± 2.78, SEM: ± 0.88) with an average %EWL of 52.7% (SD: ± 8.64%, SEM: ± 2.73%). The mean BMI at six months was 29.9 (SD:± 2.60, SEM: ± 0.98) with a mean %EWL of 68.8% (SD: ± 8.38%, SEM:± 3.17%). Complete remission of co-morbid conditions was observed in four patients, improvement in three others, and no change in a single patient. The mean duration of hospitalization was 3.1 days. The mean follow-up period was 161 days (SD:± 57.4 days, range: 90-243 days). There was no mortality and no intra-operative and post-operative complications were noted. The

  7. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients.

    Science.gov (United States)

    Garg, Harshit; Vigneshwaran, Balasubiramaniyan; Aggarwal, Sandeep; Ahuja, Vineet

    2017-01-01

    The aim of this study was to analyse the impact of hiatal hernia repair (HHR) on gastro-oesophageal reflux disease (GERD) in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG). It is a retrospective study involving ten morbidly obese patients with large hiatus hernia diagnosed on pre-operative endoscopy who underwent LSG and simultaneous HHR. The patients were assessed for symptoms of GERD using a Severity symptom score (SS) questionnaire and anti-reflux medications. Of the ten patients, five patients had GERD preoperatively. At the mean follow-up of 11.70 ± 6.07 months after surgery, four patients (80%) showed complete resolution while one patient complained of persistence of symptoms. Endoscopy in this patient revealed resolution of esophagitis indicating that the persistent symptoms were not attributable to reflux. The other five patients without GERD remained free of any symptom attributable to GERD. Thus, in all ten patients, repair of hiatal hernia (HH) during LSG led to either resolution of GERD or prevented any new onset symptom related to GER. In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG.

  8. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients

    Directory of Open Access Journals (Sweden)

    Harshit Garg

    2017-01-01

    Full Text Available Background: The aim of this study was to analyse the impact of hiatal hernia repair (HHR on gastro-oesophageal reflux disease (GERD in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG. Materials and Methods: It is a retrospective study involving ten morbidly obese patients with large hiatus hernia diagnosed on pre-operative endoscopy who underwent LSG and simultaneous HHR. The patients were assessed for symptoms of GERD using a Severity symptom score (SS questionnaire and anti-reflux medications. Results: Of the ten patients, five patients had GERD preoperatively. At the mean follow-up of 11.70 ± 6.07 months after surgery, four patients (80% showed complete resolution while one patient complained of persistence of symptoms. Endoscopy in this patient revealed resolution of esophagitis indicating that the persistent symptoms were not attributable to reflux. The other five patients without GERD remained free of any symptom attributable to GERD. Thus, in all ten patients, repair of hiatal hernia (HH during LSG led to either resolution of GERD or prevented any new onset symptom related to GER. Conclusion: In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG.

  9. Results of More Than 11,800 Sleeve Gastrectomies: Data Analysis of the German Bariatric Surgery Registry.

    Science.gov (United States)

    Stroh, Christine; Köckerling, Ferdinand; Volker, Lange; Frank, Benedix; Stefanie, Wolff; Christian, Knoll; Christiane, Bruns; Thomas, Manger

    2016-05-01

    Laparoscopic sleeve gastrectomy (SG) is an upcoming procedure in bariatric surgery and is currently performed worldwide. Staple line leakage, as the most frequent and most feared complication, is still a major concern. Since 2005 data from patients undergoing bariatric procedures in Germany have been prospectively registered in an online database and analyzed. All patients who had undergone primary SG within a 7-year period were considered for analysis. Using the German Bariatric Surgery Registry, data from more than 11,800 SGs were collected between January 1, 2005, and December 31, 2013. Staple line leak rate decreased from 6.5% to 1.4%. Male sex, higher body mass index, concomitant sleep apnea, conversion to laparotomy, longer operation time, a combination of buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate compared with when using either buttresses or oversewing alone. On multivariable analysis, operation time and year of procedure only had a significant impact on staple line leakage rate. Owing to the growing experience a constant decrease in the leakage rate after SG has been observed. Staple line disruption may still lead to sepsis, multiorgan dysfunction, and increased mortality. The results of the current study demonstrated that there are factors that increase the risk of leakage and which would enable surgeons to define risk groups, select patients more carefully, and offer closer follow-up during the postoperative course with early recognition and adequate treatment.

  10. Laparoscopic Sleeve Gastrectomy for Morbid Obesity in Patients After Orthotopic Liver Transplant: a Matched Case-Control Study.

    Science.gov (United States)

    Tsamalaidze, Levan; Stauffer, John A; Arasi, Lisa C; Villacreses, Diego E; Franco, Jose Salvador Serrano; Bowers, Steven; Elli, Enrique F

    2018-02-01

    Obesity is frequently encountered in patients with orthotopic liver transplant (OLT). The role of bariatric surgery is still unclear for this specific population. The aim of this study was to review our experience with laparoscopic sleeve gastrectomy (LSG) after OLT. We performed a retrospective case-control study of patients undergoing LSG after OLT from 2010 to 2016. OLT-LSG patients were matched by age, sex, body mass index (BMI), and year to non-OLT patients undergoing LSG. Demographics, operative variables, postoperative events, and long-term weight loss with comorbidity resolution were collected and compared between cases and controls. Of 303 patients undergoing LSG, 12 (4%) had previous OLT. They were matched to 36 non-OLT patients. No difference was found between groups in the American Society of Anesthesiologists class, mean operative time, or postoperative morbidity. The non-OLT group, however, had a significantly shorter mean hospital stay than the OLT group (1.7 vs 3.1 days; P OLT patients had significantly more excess body weight loss at 2 years (53.7 vs 45.2%; P OLT in appropriately selected patients appears to have similar outcomes to LSG in non-OLT patients.

  11. Is type 2 diabetes really resolved after laparoscopic sleeve gastrectomy? Glucose variability studied by continuous glucose monitoring.

    Science.gov (United States)

    Capoccia, D; Coccia, F; Guida, A; Rizzello, M; De Angelis, F; Silecchia, G; Leonetti, F

    2015-01-01

    The study was carried out on type 2 diabetic obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Patients underwent regular glycemic controls throughout 3 years and all patients were defined cured from diabetes according to conventional criteria defined as normalization of fasting glucose levels and glycated hemoglobin in absence of antidiabetic therapy. After 3 years of follow-up, Continuous Glucose Monitoring (CGM) was performed in each patient to better clarify the remission of diabetes. In this study, we found that the diabetes resolution after LSG occurred in 40% of patients; in the other 60%, even if they showed a normal fasting glycemia and A1c, patients spent a lot of time in hyperglycemia. During the oral glucose tolerance test (OGTT), we found that 2 h postload glucose determinations revealed overt diabetes only in a small group of patients and might be insufficient to exclude the diagnosis of diabetes in the other patients who spent a lot of time in hyperglycemia, even if they showed a normal glycemia (<140 mg/dL) at 120 minutes OGTT. These interesting data could help clinicians to better individualize patients in which diabetes is not resolved and who could need more attention in order to prevent chronic complications of diabetes.

  12. Effects of sleeve gastrectomy on the composition and diurnal oscillation of gut microbiota related to the metabolic improvements.

    Science.gov (United States)

    Shao, Yikai; Shen, Qiwei; Hua, Rong; Evers, Simon S; He, Kai; Yao, Qiyuan

    2018-03-07

    Disruptions of the composition and diurnal oscillation of gut microbiota are involved in metabolic disorders. To identify alterations in both the composition and diurnal oscillation of gut microbiota after high-fat diet (HFD) feeding and sleeve gastrectomy (SG) related to host metabolic status. University laboratories. Twenty-one 6-week-old male C57 BL/6 J mice were randomized on an HFD (n = 14) or normal chow (NC, n = 7). After 14 weeks of feeding, HFD-induced obese mice were randomized to receive either SG or sham surgery (n = 7 in each group). Fecal samples were collected every 6 hours over a 24-hour period at 14 weeks of NC or HFD feeding and subsequently 8 weeks after surgery. The composition and diurnal oscillation of gut microbiota were characterized using next-generation Illumina sequencing of 16 S rDNA. HFD feeding led to adiposity, disrupted composition, and impaired diurnal oscillation of gut microbiota relative to NC. After surgery, SG mice had considerable weight loss, improved glucose tolerance, and insulin sensitivity compared with sham mice. SG restored the reduced richness and disruptions in the composition of gut microbiota. The diminished diurnal oscillation of gut microbiota was improved after SG. SG not only changed the disrupted composition of gut microbiota toward that of NC feeding, but also improved the dampened diurnal oscillation of gut microbiota due to HFD feeding. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  13. The role of proximal versus distal stomach resection in the weight loss seen after vertical sleeve gastrectomy

    Science.gov (United States)

    Kulkarni, Bhushan V.; LaSance, Kathleen; Sorrell, Joyce E.; Lemen, Lisa; Woods, Stephen C.; Seeley, Randy J.

    2016-01-01

    The mechanisms involved in the weight loss seen after vertical sleeve gastrectomy (VSG) are not clear. The rat stomach has two morphologically and functionally distinct proximal and distal parts. The rat model for VSG involves complete removal of the proximal part and 80% removal of the distal part along the greater curvature. The purpose of this study was to understand the potential independent contributions of removal of these distinct gastric sections to VSG outcomes. We prepared four surgical groups of male Long-Evans rats: VSG, sham surgery (control), selective proximal section removal (PR), and selective distal section removal (DR). Gastric emptying rate (GER) was highest after VSG compared with all other groups. However, PR, in turn, had significantly greater GER compared with both DR and sham groups. The surgery-induced weight loss followed the same pattern with VSG causing the greatest weight loss and PR having greater weight loss compared with DR and sham groups. The results were robust for rats fed regular chow or a high-fat diet. Body mass analysis revealed that the weight loss was due to the loss of fat mass, and there was no change in lean mass after the surgeries. In conclusion, removal of the proximal stomach contributes to most, but not all, of the physiological impact of VSG. PMID:27581811

  14. Evaluation of insulin resistance improvement after laparoscopic sleeve gastrectomy or gastric bypass surgery with HOMA-IR.

    Science.gov (United States)

    Zhu, Yubing; Sun, Zhipeng; Du, Yanmin; Xu, Guangzhong; Gong, Ke; Zhu, Bin; Zhang, Nengwei

    2017-01-01

    Our purpose was to explore the remission of insulin resistance after bariatric surgery to discover the mechanism of diabetes remission excluding dietary factors. A retrospective case control study was conducted on patients with type 2 diabetes, who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric bypass surgery (LGB) in Beijing Shijitan Hospital from April 1, 2012 to April 1, 2013. The laboratory and anthropometric data was analyzed pre-surgery and during a 2-year follow-up. HOMA-IR was calculated and evaluated. The two surgical procedures were compared. No significant difference in complete remission rate was observed between the two groups (LGB group: 62.1%, LSG group: 60.0%, p = 0.892). HOMA-IR was reduced to a stable level at the 3 rd month after surgery. The cut-off value of HOMA-IR was 2.38 (sensitivity: 0.938, specificity: 0.75) and 2.33 (sensitivity: 0.941, specificity: 0.778) respectively for complete remission after LSG or LGB surgery. Insulin resistance was improved while GLP-1 and Ghrelin was changed significantly in patients with type 2 diabetes prior to weight loss either in the LSG or LGB group. HOMA-IR decreased to less than the cut-off value at the 3 rd month and was closely related to complete remission. The mechanism of bariatric surgery was not due just to simply dietary factors or body weight loss but also the remission of insulin resistance.

  15. Metabolic, behavioral, and reproductive effects of vertical sleeve gastrectomy in an obese rat model of polycystic ovary syndrome.

    Science.gov (United States)

    Ressler, Ilana B; Grayson, Bernadette E; Seeley, Randy J

    2014-06-01

    Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of reproductive age. Its clinical expression is diverse, including metabolic, behavioral, and reproductive effects, with many affected by obesity and decreased quality of life. Women with PCOS who have undergone surgically induced weight loss have reported tremendous benefit, not only with weight loss, but also improvement of hyperandrogenism and menstrual cyclicity. In a rat model of PCOS achieved via chronic administration of dihydrotestosterone (DHT) exposure, we investigated the ability of bariatric surgery, specifically vertical sleeve gastrectomy (VSG), to ameliorate the metabolic, behavioral, and reproductive abnormalities invoked by this PCOS model. We found that DHT treatment combined with exposure to a high-fat diet resulted in increased body weight and body fat, impaired fasting glucose, hirsutism, anxiety, and irregular cycles. VSG resulted in reduced food intake, body weight, and adiposity with improved fasting glucose and triglycerides. VSG induced lower basal corticosterone levels and attenuated stress responsivity. Once the DHT levels decreased to normal, regular estrous cyclicity was also restored. VSG, therefore, improved PCOS manifestations in a comprehensive manner and may represent a potential therapeutic approach for specific aspects of PCOS.

  16. Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Frask, Agata; Orłowski, Michał; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Gajewski, Krzysztof; Michalik, Maciej

    2017-06-01

    Among the most common early complications after bariatric surgery are anastomosis leak and bleeding. In order to react quickly and perform accurate treatment before the clinical signs appear, early predictors should be found. In the study C-reactive protein (CRP) and procalcitonin (PCT) levels were investigated. Characterized by a relatively short half-life, they can predict surgical complications. To develop and implement certain standards for early detection of complications. The study involved 319 adults who underwent laparoscopic sleeve gastrectomy (LSG) as a surgical intervention for morbid obesity at the Department of General Surgery of Ceynowa Hospital in Wejherowo. Every patient had CRP and PCT levels measured before the surgery and on the 1 st and 2 nd postoperative day (POD). Early postoperative complications occurred in 19 (5.96%) patients. Septic and non-septic complications occurred in 3 and 16 patients respectively. Among the patients with septic postoperative complications CRP level increased significantly on the 2 nd POD compared to the remainder (p = 0.0221). Among the patients with non-septic postoperative complications CRP level increased significantly on the 1 st and 2 nd POD compared to the remainder. Among the patients with septic and non-septic postoperative complications PCT level increased significantly on the 2 nd POD compared to the remainder. The CRP and PCT level are supposed to be relevant diagnostic markers to predict non-septic and septic complications after LSG.

  17. Sleeve Gastrectomy Combined with the Simplified Hill Repair in the Treatment of Morbid Obesity and Gastro-esophageal Reflux Disease: Preliminary Results in 14 Patients.

    Science.gov (United States)

    Gero, Daniel; Ribeiro-Parenti, Lara; Arapis, Konstantinos; Marmuse, Jean-Pierre

    2017-04-01

    Our aim is to report our initial experience with a novel technique which addresses morbid obesity and gastro-esophageal reflux disease (GERD) simultaneously by combination of laparoscopic sleeve gastrectomy (LSG) and simplified laparoscopic Hill repair (sLHR). Retrospective analysis of LSG+sLHR patients >5 months postoperatively includes demographics, GERD status, proton-pump inhibitor (PPI) use, body mass index (BMI), excess BMI loss (EBMIL), complications and GERD-Health Related Quality of Life (GERD-HRQL) questionnaire. LSG+sLHR surgical technique: posterior cruroplasty,  standard LSG, fixation of the esophagogastric junction to the median arcuate ligament. Fourteen patients underwent LSG+sLHR [12 women and 2 men, mean (range) age 47 years (27-57), BMI 41 kg/m 2 (35-65)]. Five patients had previous gastric banding (GB). All had symptomatic GERD confirmed by gastroscopy and/or upper-gastrointestinal contrast study, two with chronic cough, 10 took PPI daily. Twelve had hiatus hernia and two patulous cardia at surgical exploration. Associated interventions were three GB removals and one cholecystectomy. Postoperative complication was one surgical site infection. Follow-up of all patients at median 12.5 months (5-17) is as follows: symptomatic GERD 3/14 patients, chronic cough 0/14, daily PPI use in 1/14, mean EBMIL 68% (17-120), satisfaction 93%, mean GERD-HRQL score 3,28/50 (0-15), with 4 patients 0/50, occasional bloatedness in 2 patients and dysphagia not reported. The novel technique which combines LSG with sLHR is feasible, safe and can be associated with GB removal. Preliminary results showed patient satisfaction, high remission rate of preexisting GERD, decrease in PPI use and unimpaired weight loss. Further evaluation is necessary in a controlled and staged manner to establish the technique's real effectiveness.

  18. Effects of Laparoscopic Sleeve Gastrectomy on Central Obesity and Metabolic Syndrome in Indian Adults- A Prospective Study.

    Science.gov (United States)

    Sethi, Pulkit; Thillai, Manoj; Nain, Prabhdeep Singh; Ahuja, Ashish; Vayoth, Sudheer Othiyil; Khurana, Preetika

    2017-01-01

    Increasing incidence of obesity in Indian population has led to an exponential rise in the number of bariatric operations performed annually. Laparoscopic Sleeve Gastrectomy (LSG) has been proposed to cause rapid remission of Type 2 Diabetes Melitus (T2DM) and metabolic syndrome in a weight loss independent manner. To evaluate the effects of LSG on metabolic syndrome and central obesity in morbidly and severely obese Indian adults. Material and Methods: Study was conducted on 91 morbidly obese [Body Mass Index (BMI)>40 kg/m 2 ] and severely obese (BMI>35 kg/m 2 ) individuals who were suffering from diabetes, hypertension or dyslipidemia. The patients were followed up for six months and the trends of glycaemic control, mean blood pressure, lipid profile, weight loss parameters and changes in parameters of central obesity were studied. Weight loss was significant at three months postsurgery and was sustained through six months. There was significant improvement in glycaemic control leading to reduction in need for oral hypoglycaemic agents or insulin in majority of them and even discontinuation of these medications in few patients. Hypertension and dyslipidemia also showed an improving trend through six months postsurgery. There was a significant impact on reduction of central obesity in these patients as marked by significant reduction in waist to hip ratio. LSG produces sustainable weight loss with significant improvement in glycaemic status and control of metabolic syndrome in severe to morbidly obese patients. LSG is also efficacious in reducing central obesity in Indian population which is a major depressive ailment amongst obese individuals.

  19. Gastroesophageal reflux disease and Barrett's esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication.

    Science.gov (United States)

    Genco, Alfredo; Soricelli, Emanuele; Casella, Giovanni; Maselli, Roberta; Castagneto-Gissey, Lidia; Di Lorenzo, Nicola; Basso, Nicola

    2017-04-01

    Morbidly obese patients are affected by gastroesophageal reflux disease (GERD) and hiatal hernia (HH) more frequently than lean patients. Because of conflicting results, the indication to sleeve gastrectomy (SG) in patients with GERD is still debated. To evaluate the incidence of GERD on the basis of clinical, endoscopic, and histologic data in patients undergoing SG. University hospital, Rome, Italy. From July 2007 to January 2010, 162 patients underwent primary SG. Preoperatively all patients underwent visual analogue scale (VAS) evaluation of GERD symptoms, proton pump inhibitors (PPIs) consumption recording, and esophagogastroduodenoscopy (EGD). Stomach resection started 6 cm from pylorus on a 48Fr bougie. Staple line was reinforced by an oversewing suture. A postoperative clinical control with VAS evaluation, PPI consumption, and EGD was proposed to all patients. Three patients were excluded because of the occurrence of major postoperative complications. A total of 110 patients accepted to take part in the study (follow-up rate: 69.1%). At a mean 58 months of follow-up, incidence of GERD symptoms, VAS mean score, and PPI intake significantly increased compared with preoperative values (68.1% versus 33.6%: Preflux was found in 73.6% and 74.5% of cases, respectively. A significant increase in the incidence and in the severity of erosive esophagitis (EE) was evidenced, whereas nondysplastic Barrett's esophagus (BE) was newly diagnosed in 19 patients (17.2%). No significant correlations were found between GERD symptoms and endoscopic findings. In the present series the incidence of EE and of BE in SG patients was considerably higher than that reported in the current literature, and it was not related to GERD symptoms. Endoscopic surveillance after SG should be advocated irrespective of the presence of GERD symptoms. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  20. Does Weight Gain During the Operation Wait Time Have an Impact on Weight Loss After Laparoscopic Sleeve Gastrectomy?

    Science.gov (United States)

    Cayci, Haci Murat; Erdogdu, Umut Eren; Karaman, Kerem; Budak, Ersin; Taymur, İbrahim; Buyukuysal, Cagatay

    2017-02-01

    The effect of preoperative weight changes on postoperative outcomes after bariatric surgery remains inconclusive. The aim of the present study was to evaluate the effect of preoperative weight gain on postoperative weight loss outcomes after laparoscopic sleeve gastrectomy (SG). Ninety-two morbidly obese patients undergoing SG from January 2014 to April 2016 were separated into two groups according to whether they gained weight or not during the waiting time prior to surgery. Thirty-nine patients (42.4 %) gained weight during the waiting time and 53 patients (57.6 %) did not. The median body mass index (BMI; kg/m 2 ) at surgery was significantly higher in weight-gained patients (47.8 (min-max, 40-62)) compared to patients who had not gained weight (45.10 (min-max, 41-67)), (P = 0.034). No significant difference was found between the two groups regarding the distribution of age, gender, family history of obesity, existence of comorbidity, smoking, weight gain during childhood or adulthood, preoperative Beck depression and Beck anxiety scores, waiting time period, and body weight at the initial visit (P > 0.05). The ASA I score was higher in weight-gained patients whereas ASA II score was higher in those who did not gain, and the difference was significant (P = 0.046). Postoperative % BMI loss and % weight loss were not significantly different between the two groups at the first, third, sixth months, and the end of the first year (P > 0.05). Weight gain during waiting time has no negative impact on % weight loss and % BMI loss after SG.

  1. 3D Volumetry and its Correlation Between Postoperative Gastric Volume and Excess Weight Loss After Sleeve Gastrectomy.

    Science.gov (United States)

    Hanssen, Andrés; Plotnikov, Sergio; Acosta, Geylor; Nuñez, José Tomas; Haddad, José; Rodriguez, Carmen; Petrucci, Claudia; Hanssen, Diego; Hanssen, Rafael

    2018-03-01

    The volume of the postoperative gastric remnant is a key factor in excess weight loss (EWL) after sleeve gastrectomy (SG). Traditional methods to estimate gastric volume (GV) after bariatric procedures are often inaccurate; usually conventional biplanar contrast studies are used. Thirty patients who underwent SG were followed prospectively and evaluated at 6 months after the surgical procedure, performing 3D CT reconstruction and gastric volumetry, to establish its relationship with EWL. The gastric remnant was distended with effervescent sodium bicarbonate given orally. Helical CT images were acquired and reconstructed; GV was estimated with the software of the CT device. The relationship between GV and EWL was analyzed. The study allowed estimating the GV in all patients. A dispersion diagram showed an inverse relationship between GV and %EWL. 55.5% of patients with GV ≤ 100 ml had %EWL 25-75% and 38.8% had an %EWL above 75% and patients with GV ≥ 100 ml had an %EWL under 25% (50% of patients) or between 25 and 75% (50% of this group). The Pearson's correlation coefficient was R = 6.62, with bilateral significance (p ≤ .01). The Chi-square result correlating GV and EWL showed a significance of .005 (p ≤ .01). The 3D reconstructions showed accurately the shape and anatomic details of the gastric remnant. 3D volumetry CT scans accurately estimate GV after SG. A significant relationship between GV and EWL 6 months after SG was established, seeming that GV ≥ 100 ml at 6 months of SG is associated with poor EWL.

  2. Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: Incidence, Analysis and Follow-Up in 1236 Consecutive Cases.

    Science.gov (United States)

    Villagrán, Rodrigo; Smith, Gabriela; Rodriguez, Walter; Flores, Carlos; Cariaga, Mario; Araya, Sofía; Yañez, Marisol; Fuentes, Paulina; Linares, Jeannette; Zapata, Antonio

    2016-11-01

    Portomesenteric vein thrombosis (PMVT) is a rare but severe complication after laparoscopic bariatric surgery, with potentially serious consequences. We aimed to describe the incidence, clinical features, management, outcome, and midterm follow-up in patients with PMVT after laparoscopic sleeve gastrectomy (LSG). This retrospective and descriptive study included patients who underwent LSG between November 2009 and July 2015 and developed PMVT. The following data were analyzed: age, gender, body mass index (BMI), thrombosis risk factors, surgical technique, thromboembolic prophylaxis, primary surgery outcomes, clinical features, treatment, thrombophilia testing results, and follow-up findings, including imaging and endoscopic findings. A total of 1236 patients underwent LSG, and 5 (0.4 %) developed PMVT. The mean age was 34.4 years, and 3 patients were women. The mean BMI was 38.5 kg/m 2 . Two patients had received hormonal contraceptive treatment. Four patients had a history of smoking. All of the patients received anticoagulant treatment, and none required surgery. The mean hospitalization duration was 7.6 days. Two patients showed complete recanalization. One patient showed portal cavernomatosis on delayed images. Two patients had a positive thrombophilia test. No portal hypertension endoscopic findings were observed. PMVT is a rare complication, for which smoking was identified as a predominant risk factor. Early diagnosis and prompt anticoagulant therapy could lead to a dramatic decrease in the incidence of intestinal infarction, mortality, and extrahepatic portal hypertension in the near future. However, careful follow-up is necessary to evaluate the impact of PMVT on long-term patient outcomes.

  3. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial.

    Science.gov (United States)

    Salminen, Paulina; Helmiö, Mika; Ovaska, Jari; Juuti, Anne; Leivonen, Marja; Peromaa-Haavisto, Pipsa; Hurme, Saija; Soinio, Minna; Nuutila, Pirjo; Victorzon, Mikael

    2018-01-16

    Laparoscopic sleeve gastrectomy for treatment of morbid obesity has increased substantially despite the lack of long-term results compared with laparoscopic Roux-en-Y gastric bypass. To determine whether laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass are equivalent for weight loss at 5 years in patients with morbid obesity. The Sleeve vs Bypass (SLEEVEPASS) multicenter, multisurgeon, open-label, randomized clinical equivalence trial was conducted from March 2008 until June 2010 in Finland. The trial enrolled 240 morbidly obese patients aged 18 to 60 years, who were randomly assigned to sleeve gastrectomy or gastric bypass with a 5-year follow-up period (last follow-up, October 14, 2015). Laparoscopic sleeve gastrectomy (n = 121) or laparoscopic Roux-en-Y gastric bypass (n = 119). The primary end point was weight loss evaluated by percentage excess weight loss. Prespecified equivalence margins for the clinical significance of weight loss differences between gastric bypass and sleeve gastrectomy were -9% to +9% excess weight loss. Secondary end points included resolution of comorbidities, improvement of quality of life (QOL), all adverse events (overall morbidity), and mortality. Among 240 patients randomized (mean age, 48 [SD, 9] years; mean baseline body mass index, 45.9, [SD, 6.0]; 69.6% women), 80.4% completed the 5-year follow-up. At baseline, 42.1% had type 2 diabetes, 34.6% dyslipidemia, and 70.8% hypertension. The estimated mean percentage excess weight loss at 5 years was 49% (95% CI, 45%-52%) after sleeve gastrectomy and 57% (95% CI, 53%-61%) after gastric bypass (difference, 8.2 percentage units [95% CI, 3.2%-13.2%], higher in the gastric bypass group) and did not meet criteria for equivalence. Complete or partial remission of type 2 diabetes was seen in 37% (n = 15/41) after sleeve gastrectomy and in 45% (n = 18/40) after gastric bypass (P > .99). Medication for dyslipidemia was discontinued in 47% (n

  4. Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity?

    Science.gov (United States)

    Benedix, Frank; Benedix, Diana D; Knoll, Christian; Weiner, Rudolf; Bruns, Christiane; Manger, Thomas; Stroh, Christine

    2014-10-01

    Laparoscopic sleeve gastrectomy (LSG) is currently being performed with increasing frequency worldwide. It offers an excellent weight loss and resolution of comorbidities in the short term with a very low incidence of complications. However, the ever present risk of a staple line leak is still a major concern. Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered in an online database and analyzed at the Institute of Quality Assurance in Surgical Medicine. For the current analysis, all patients that had undergone primary sleeve gastrectomy for morbid obesity within a 7-year period were considered. Using the GBSR, data from 5.400 LSGs were considered for analysis. Staple line leak rate decreased during the study period from 6.5 to 1.4 %. Male gender, higher BMI, concomitant sleep apnea, conversion to laparotomy, longer operation time, use of both buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate. On multivariate analysis, operation time and year of procedure only had a significant impact on staple line leak rate. The results of the current study demonstrated that there are factors that increase the risk of a leakage which would enable surgeons to define risk groups, to more carefully select patients, and to offer a closer follow-up during the postoperative course with early recognition and adequate treatment. All future efforts should be focused on a further reduction of serious complications to make the LSG a widely accepted and safer procedure.

  5. Self-esteem and quality of life in adolescents with extreme obesity in Saudi Arabia: the effect of weight loss after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Aldaqal, Saleh M; Sehlo, Mohammad G

    2013-01-01

    To evaluate the self-esteem and quality of life in adolescents with extreme obesity before and one year after laparoscopic sleeve gastrectomy as obesity is a major challenging medical problem, not only in adults but also in children and adolescents in Saudi Arabia. In a prospective cohort study, 32 adolescents (aged 13-17 years) with extreme obesity (Group 1) presenting for laparoscopic sleeve gastrectomy (LSG) were compared with 32 matched, healthy, nonobese adolescents (aged 14-17 years) (Group 2) with regards to self-esteem and quality of life. Assessment was done using the Rosenberg Self-Esteem Scale and Pediatric Quality of Life Inventory version 4.0 (self- and parent report), respectively. Body mass index (BMI) Z scores were calculated for both groups. We found significantly poor self-esteem and impairment in all domains of quality of life (self- and parent report) in Group 1 compared with Group 2 (Pself-esteem (R2=0.28 and P=.003) and quality of life (R(2)=0.67 and Padolescents with extreme obesity: LSG leads to weight loss, with subsequent improvement in self-esteem and quality of life. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. The Effect of Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease in the Morbidly Obese.

    Science.gov (United States)

    Samakar, Kamran; McKenzie, Travis J; Tavakkoli, Ali; Vernon, Ashley H; Robinson, Malcolm K; Shikora, Scott A

    2016-01-01

    The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) is controversial. Although concomitant hiatal hernia repair (HHR) at the time of LSG is common and advocated by many, there are few data on the outcomes of GERD symptoms in these patients. The aim of this study was to evaluate the effect of concomitant HHR on GERD symptoms in morbidly obese patients undergoing LSG. A single institution, multi-surgeon, prospectively maintained database was examined to identify patients who underwent LSG and concomitant HHR from December 2010 to October 2013. Patient characteristics, operative details, and postoperative outcomes were analyzed. Standardized patient questionnaires administered both pre- and postoperatively were utilized. Primary endpoints included subjective reflux symptoms and the need for antisecretory therapy. Weight loss was considered a secondary endpoint. Fifty-eight patients were identified meeting inclusion criteria (LSG + HHR), with a mean follow-up of 97.5 weeks (range 44-172 weeks). The mean age of the cohort was 49.5 ± 11.2 years, with 74.1 % being female. Mean preoperative BMI was 44.2 ± 6.6 kg/m(2). Preoperative upper gastrointestinal contrast series was performed in all patients and demonstrated a hiatal hernia in 34.5 % of patients and reflux in 15.5 % of patients. Preoperatively, 44.8 % (n = 26) of patients reported subjective symptoms of reflux and/or required daily antisecretory therapy [Corrected]. After LSG + HHR, 34.6 % of symptomatic patients had resolution of their symptoms off therapy while the rest remained symptomatic and required daily antisecretory therapy; 84.4 % of patients that were asymptomatic preoperatively remained asymptomatic after surgery. New onset reflux symptoms requiring daily antisecretory therapy was seen in 15.6 % of patients who were previously asymptomatic. Post surgical weight loss did not correlate with the presence or resolution of reflux symptoms. Based

  7. Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry.

    Science.gov (United States)

    Sánchez-Santos, Raquel; Masdevall, Carlos; Baltasar, Aniceto; Martínez-Blázquez, Candido; García Ruiz de Gordejuela, Amador; Ponsi, Enric; Sánchez-Pernaute, Andres; Vesperinas, Gregorio; Del Castillo, Daniel; Bombuy, Ernest; Durán-Escribano, Carlos; Ortega, Luis; Ruiz de Adana, Juan Carlos; Baltar, Javier; Maruri, Ignacio; García-Blázquez, Emilio; Torres, Antonio

    2009-09-01

    Reports on laparoscopic sleeve gastrectomy (LSG) communicate very good short-term results on very high-risk morbid obese patients. However, mid- and long-term results are still unknown. A National Registry has been created in Spain to achieve information on the outcomes of this bariatric procedure. Data were obtained from 17 centers and collected in a database. Technical issues, preoperative comorbid conditions, hospital stay, early and late complications, and short- and mid-term weight loss were analyzed. Five hundred forty patients were included; 76% were women. Mean BMI was 48.1 +/- 10. Mean age was 44.1 +/- 11.8. Morbidity rate was 5.2% and mortality rate 0.36%. Complications presented more frequently in superobese patients (OR, 2.8 (1.18-6.65)), male (OR, 2.98 (1.26-7.0)), and patients >55 years old (OR, 2.8 (1.14-6.8)). Staple-line reinforcement was related to a lower complication rate (3.7 vs 8.8%; p = 0.039). Mean hospital stay was 4.8 +/- 8.2 days. Mean follow-up was 16.5 +/- 10.6 months (1-73). Mean percent excess BMI loss (EBL) at 3 months was 38.8 +/- 22, 55.6 +/- 8 at 6 months, 68.1 +/- 28 at 12 months, and 72.4 +/- 31 at 24 months. %EBL was superior in patients with lower initial BMI and lower age. Bougie caliber was an inverse predictive factor of %EBL at 12 and 24 months (RR, 23.3 (11.4-35.2)). DM is remitted in 81% of the patients and HTA improved in 63.2% of them. A second-stage surgery was performed in 18 patients (3.2%). LSG provides good short- and mid-term results with a low morbid-mortality rate. Better results are obtained in younger patients with lowest BMI. Staple-line reinforcement and a thinner bougie are recommended to improve outcome.

  8. Effects of Weight Reduction After Sleeve Gastrectomy on Metabolic Variables in Saudi Obese Subjects in Aseer Province of Kingdom of Saudi Arabia.

    Science.gov (United States)

    Bawahab, Mohammed A; Assiri, Abdullah S; Maksoud, Walid Abdel; Patel, Ayyub; Kadoumi, Osama; Zaman, Gaffar Sarwar; Alessih, Riyad Mohammed Khalil; Haider, Syed Saleem

    2017-08-01

    The objectives of this study were to investigate the occurrence of oxidative stress, status of protective antioxidants enzymes, inflammatory biomarkers, and some metabolic health variables in the blood and to compare the results between those of the normal controls and obese patients submitted to sleeve gastrectomy-induced weight loss over a 1-year follow-up period. A prospective study was conducted in Aseer Central Hospital and Abha Private Hospital in the Kingdom of Saudi Arabia from January 2012 to January 2013 on 50 normal (BMI = 22-25 kg/m 2 ) control subjects and 50 obese (BMI = 45-50 kg/m 2 ) patients. A subset of 20 men and 80 women patients, aged 20-45 years, was included. The systemic blood cell counts were determined by Beckman Coulter UniCel analyzer. The occurrence of oxidative stress, the status of antioxidant enzyme system in the blood, levels of serum hepatic enzymes, cardiovascular risk factors, and serum sodium, potassium, copper, and zinc levels were determined by spectrophotometric procedures. The concentration of TSH and T 4 were analyzed by Siemens Immunoassay System. Group 1 (Obese: preoperative) This group compared with the normal controls exhibited significant (p copper and zinc levels were significantly (p phosphate dehydrogenase (G6PDH), and vitamin C, were remarkably (p potassium, copper, zinc, and TSH levels were significantly (p < 0.001) decreased. Obesity is a chronic disease of multifactorial origin and resulted in perturbations of whole body metabolism in this study. It is thus likely that this imbalance was associated with an inhibition in protective antioxidants and occurrence of oxidative stress. The staging concept of sleeve gastrectomy is a safe and effective approach with remarkable efficacy in sustaining weight loss and bringing back normal metabolism of variables in tissues over a 1-year follow-up period.

  9. Pattern of changes in quality of life of obese patients after sleeve gastrectomy in Sulaimani provence –Kurdistan-Iraq, based on 4 years experience in two bariatric centers

    Directory of Open Access Journals (Sweden)

    Hiwa Omer Ahmed

    2018-02-01

    Full Text Available Background: Obesity influences all aspects of the life of obese patients physically, psychologically, socially and monetarily, it is not only a disease but rather a beginning point of a group of ailments and inabilities, which gradually impacts and changes all aspects of their life. Objectives: The changes in the Quality of life in respect to the amount of access weight lost after sleeve gastrectomy. Patients, materials and methods: A prospective longitudinal study evaluating 40 female patients who underwent laparoscopic sleeve gastrectomy within 4 years, starting from July 4th, 2012 up to July 5th, 2016. Results: More than three-quarter of the patients were not satisfied with their body before their operation, but six to twelve months after their weight loss; (N = 36, 90% of them were satisfied with their new body image. Half of the patients were unhappy before their operation, but twelve months later (N = 31, 77.5% of them became much happier. Regarding satisfaction with the body image, noticeable improvement occurred since (N = 36, 90% of them were satisfied with their new body image. While, most of them have had low self-esteem and (N 27, 67.5% of the patients had no self-esteem at all, 12 months after the operation (N = 35, 87.5% felt great improvement in their self-esteem (p-value = .040. A significant decrease in appetite was noticed in (N = 39, 97.5% of the patients after 12 months. Conclusion: Significant changes in the parallel pattern to the extent of EWL were noticed in the quality of life of morbidly obese patients after laparoscopic sleeve gastrectomy. Keywords: A pattern, Parallel, Reverse-pattern, Laparoscopic sleeve gastrectomy, Quality of life, Non-health quality of life, Morbid obesity

  10. Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm

    Directory of Open Access Journals (Sweden)

    Palanivelu Praveenraj

    2016-01-01

    Full Text Available Background: Laparoscopic sleeve gastrectomy (LSG is the most commonly performed 'standalone' bariatric procedure in India. Staple line gastric leaks occur infrequently but cause significant and prolonged morbidity. The aim of this retrospective study was to analyse the management of patients with a gastric leak after LSG for morbid obesity at our institution. Patients and Methods: From February 2008 to 2014, 650 patients with different degrees of morbid obesity underwent LSG. Among these, all those diagnosed with a gastric leak were included in the study. Patients referred to our institution with gastric leak after LSG were also included. The time of presentation, site of leak, investigations performed, treatment given and time of closure of all leaks were analysed. Results: Among the 650 patients who underwent LSG, 3 (0.46% developed a gastric leak. Two patients were referred after LSG was performed at another institution. The mean age was 45.60 ± 15.43 years. Mean body mass index (BMI was 44.79 ± 5.35. Gastric leak was diagnosed 24 h to 7 months after surgery. One was early, two were intermediate and two were late leaks. Two were type I and three were type II gastric leaks. Endoscopic oesophageal stenting was used variably before or after re-surgery. Re-surgery was performed in all and included stapled fistula excision (re-sleeve, suture repair only or with conversion to roux-en-Y gastric bypass or fistula jujenostomy. There was no mortality. Conclusion: Leakage closure time may be shorter with intervention than expectant management. Sequence and choice of endoscopic oesophageal stenting and/or surgical re-intervention should be individualized according to clinical presentation.

  11. Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Absorbable Monofilament, Barbed Suture, Fibrin Glue, or Nothing? Results of a Prospective Randomized Study.

    Science.gov (United States)

    Carandina, S; Tabbara, M; Bossi, M; Valenti, A; Polliand, C; Genser, L; Barrat, Christophe

    2016-02-01

    Laparoscopic sleeve gastrectomy (LSG) is associated with serious complications, such as staple line (SL) leaks and bleeding. In order to prevent the occurrence of these complications, surgeons have advocated the need to strengthen the staple line. The aim of this randomized controlled study was to compare the efficacy of three different ways of strengthening of the SL in LSG in preventing surgical post-operative complications. Between April 2012 and December 2014, 600 patients (pts) scheduled for LSG were prospectively randomized into groups without SL reinforcement (group A) or with SL reinforcement including fibrin glue coverage (group B), or oversewn SL with imbricating absorbable (Monocryl™; group C) or barbed (V lock®) running suture (group D). Primary endpoints were post-operative leaks, bleeding, and stenosis, while secondary outcomes consisted of the time to perform the staple line reinforcement (SLR) and total operative time. Mean SLR operative time was lower for group B (3.4 ± 1.3 min) compared with that for groups C (26.8 ± 8.5 min) and D (21.1 ± 8.4 min) (p running suture or with fibrin glue, is an unrewarding surgical act with the sole effect of prolonging the operative time.

  12. Improvement in cardiovascular risk in women after bariatric surgery as measured by carotid intima-media thickness: comparison of sleeve gastrectomy versus gastric bypass.

    Science.gov (United States)

    Gómez-Martin, Jesús M; Aracil, Enrique; Galindo, Julio; Escobar-Morreale, Héctor F; Balsa, José A; Botella-Carretero, José I

    2017-05-01

    Bariatric surgery may diminish cardiovascular risk (CVR) and its associated mortality. However, studies that compare these effects with different techniques are scarce. To evaluate the changes in CVR as estimated by carotid intima-media thickness (IMT) after obesity surgery in women with high CVR as defined by the presence of metabolic syndrome. Academic hospital. We studied 40 severely obese women, of whom 20 received laparoscopic Roux en Y gastric bypass (RYGB) and 20 received sleeve gastrectomy (SG). Twenty control women matched for age and cardiovascular risk were also included. Patients and controls were evaluated at baseline and 1 year after surgery or conventional treatment with diet and exercise, respectively. Only 18 of the 20 women in the control group were available for analysis after 1 year. None of the women who had bariatric surgery was lost to follow-up. Mean carotid IMT decreased 1 year after surgery irrespective of the surgical technique used, whereas no changes were observed in the control women who had conventional therapy (Wilks´ λ = .802, P = .002 for the interaction, P = .011 for RYGB versus controls, P = .002 for SG versus controls, P = .349 for RYGB versus SG). Both RYGB and SG decrease CVR as measured by carotid IMT in obese women. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  13. Circulating adiponectin increases in obese women after sleeve gastrectomy or gastric bypass driving beneficial metabolic changes but with no relationship with carotid intima-media thickness.

    Science.gov (United States)

    Gómez-Martin, Jesús M; Balsa, José A; Aracil, Enrique; Insenser, María; Priego, Pablo; Escobar-Morreale, Héctor F; Botella-Carretero, José I

    2017-10-12

    Obesity surgery induces beneficial effects in metabolic and cardiovascular parameters. Adiponectin increase might be associated with some of these changes. However, direct comparison between different surgical techniques has not been extensively performed. We studied 20 obese women submitted to laparoscopic Roux en Y gastric bypass (RYGB) and 20 to sleeve gastrectomy (SG). Twenty control women matched for age and baseline metabolic profiles were also included. Both patients and controls were followed up for one year after surgery or conventional treatment with diet and exercise, respectively. Serum adiponectin was measured at baseline, 6 months and 1 year after, as well as lipid profiles, sex hormone binding globulin (SHBG), fasting glucose and insulin. Carotid intima-media thickness was measured by ultrasonography at baseline and after 1 year. Circulating adiponectin increased after obesity surgery (more markedly following RYGB than after SG), whereas no changes were observed in the controls (Wilks' λ = 0.659, P media thickness (r = -0.055, P = 0.679). RYGB induces a higher increase in adiponectin than SG, which parallels SHBG, the reduction of fasting insulin and insulin resistance. On the other hand, no association was found with carotid intima-media, lipid profiles or blood pressure. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  14. Evolution of subclinical hypothyroidism and its relation with glucose and triglycerides levels in morbidly obese patients after undergoing sleeve gastrectomy as bariatric procedure.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Boix, Evangelina; Galindo, Isabel; Zubiaga, Lorea; Diez, María; Arroyo, Antonio; Calpena, Rafael

    2014-05-01

    There is an increased prevalence of subclinical hypothyroidism (SCH) in patients with obesity. It is unclear if this biochemical abnormality may be a secondary phenomenon of obesity or a real hypothyroid state. A retrospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between October 2007 and November 2012 was performed. Weight loss, body mass index (BMI) and excess weight loss, baseline glucose, lipid profiles, and TSH levels were obtained before operation and postoperative determinations at 3, 6, and 12 months after surgery. Sixty patients were included. Prevalence of subclinical hypothyroidism was 16.7% preoperatively, 10% at 3 months, 3.3% at 6 months, and 1.7% at 12 months. A significant correlation could be established between TSH decrease and weight loss at 12 months (Pearson 0.603; p = 0.007). TSH decrease showed a significant correlation with glucose and glycated hemoglobin decrease from 6th month onwards. Referring to lipid profile, an association of TSH decrease with total cholesterol, LDL cholesterol, or HDL cholesterol could not be determined. A significant association between TSH decrease and triglycerides and cardiovascular risk index triglycerides/HDL cholesterol reductions could also be established 12 months after surgery. SCH is usually corrected after bariatric surgery, while there are no significant changes in total or LDL cholesterol. This suggests that, in morbidly obese subjects, SCH is, in most patients, just a consequence of the abnormal fat accumulation and not a real hypothyroid state.

  15. Liver Function in Patients With Nonalcoholic Fatty Liver Disease Randomized to Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy: A Secondary Analysis of a Randomized Clinical Trial.

    Science.gov (United States)

    Kalinowski, Piotr; Paluszkiewicz, Rafał; Ziarkiewicz-Wróblewska, Bogna; Wróblewski, Tadeusz; Remiszewski, Piotr; Grodzicki, Mariusz; Krawczyk, Marek

    2017-11-01

    The aim of the study was to compare the influence of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) on liver function in bariatric patients with non-alcoholic fatty liver disease (NAFLD) in a randomized clinical trial (NCT01806506). Rapid weight loss and malabsorption after bariatric surgery in patients with NAFLD or steatohepatitis (NASH) may impair liver function. Sixty-six morbidly obese patients randomized to SG or RYGB were included in a secondary outcome analysis. Intraoperative liver biopsies were categorized with NAFLD Activity Score (NAS) and liver function tests were done before surgery and after 1, 6 and 12 months. NASH was present in 54.5% RYGB and 51.5% SG patients (P > 0.05). At 12 months excess weight loss was 68.7 ± 19.7% after SG and 62.8 ± 18.5% after RYGB (P > 0.05). At 1 month international normalized ratio (INR) increased after RYGB (0.98 ± 0.05 vs 1.14 ± 0.11; P liver function than after SG.

  16. Effects of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass on Eating Behavior and Sweet Taste Perception in Subjects with Obesity

    Directory of Open Access Journals (Sweden)

    Katie Nance

    2017-12-01

    Full Text Available The goal of this study was to test the hypothesis that weight loss induced by Roux-en-Y gastric bypass (RYGB has greater effects on taste perception and eating behavior than comparable weight loss induced by sleeve gastrectomy (SG. We evaluated the following outcomes in 31 subjects both before and after ~20% weight loss induced by RYGB (n = 23 or SG (n = 8: (1 sweet, savory, and salty taste sensitivity; (2 the most preferred concentrations of sucrose and monosodium glutamate; (3 sweetness palatability, by using validated sensory testing techniques; and (4 eating behavior, by using the Food Craving Inventory and the Dutch Eating Behavior Questionnaire. We found that neither RYGB nor SG affected sweetness or saltiness sensitivity. However, weight loss induced by either RYGB or SG caused the same decrease in: (1 frequency of cravings for foods; (2 influence of emotions and external food cues on eating behavior; and (3 shifted sweetness palatability from pleasant to unpleasant when repetitively tasting sucrose (all p-values ≤ 0.01. Therefore, when matched on weight loss, SG and RYGB cause the same beneficial effects on key factors involved in the regulation of eating behavior and hedonic component of taste perception.

  17. Comparison of the Effect of Gastric Bypass and Sleeve Gastrectomy on Metabolic Syndrome and its Components in a Cohort: Tehran Obesity Treatment Study (TOTS).

    Science.gov (United States)

    Barzin, Maryam; Motamedi, Mohammad Ali Kalantar; Serahati, Sara; Khalaj, Alireza; Arian, Peyman; Valizadeh, Majid; Khalili, Davood; Azizi, Fereidoun; Hosseinpanah, Farhad

    2017-07-01

    Metabolic syndrome (MetS) is a prevalent counterpart of morbid obesity. With the surgical technique of sleeve gastrectomy (SG) gaining widespread acceptance for weight loss in morbid obese patients, we aimed to undertake a study to compare its effectiveness to gastric bypass (GB) for metabolic control in these patients. A total of 425 patients from a prospectively collected database of morbid obese subjects between 18 and 65 years of age undergoing a primary bariatric procedure from March 2013 to September 2015 were included. Statistical analysis was performed using general estimation equation and propensity scores, and odds ratios were calculated. Three hundred nineteen patients underwent SG and 106 underwent GB. Mean age of the patients was 37.8 ± 11.7, and mean body mass index (BMI) was 44.3 ± 5.9 kg/m 2 . MetS was present in 61.4% of patients and diabetes mellitus in 48.6%. MetS prevalence decreased from 60 and 64% in the SG and GB groups to 16 and 10% at 12 months, respectively. These improvements were consistent throughout the study period in both groups, with no significant difference between the two groups (for all variables: P trend   .05). After propensity score-adjusted analysis, neither surgical technique showed superiority over the other regarding metabolic improvement (OR for MetS resolution: 0.81, 95% CI: 0.49-1.34). In this short-term study with 1-year follow-up, SG showed similar results to GB in terms of weight loss, MetS resolution, and glycemic control in a large Middle Eastern cohort. Long-term studies are needed to further investigate the effectiveness of SG in this regard.

  18. Utility of the balloon-overtube-assisted modified over-the-wire stenting technique to treat post-sleeve gastrectomy complications.

    Science.gov (United States)

    Ponte, Ana; Pinho, Rolando; Proença, Luísa; Silva, Joana; Rodrigues, Jaime; Sousa, Mafalda; Silva, João Carlos; Carvalho, João

    2017-06-16

    To describe a modified technique of deployment of stents using the overtube developed for balloon-assisted enteroscopy in post-sleeve gastrectomy (SG) complications. Between January 2010 and December 2015, all patients submitted to an endoscopic stenting procedure to treat a post-SG stenosis or leakage were retrospectively collected. Procedures from patients in which the stent was deployed using the balloon-overtube-assisted modified over-the-wire (OTW) stenting technique were described. The technical success, corresponding to proper placement of the stent in the stomach resulting in exclusion of the SG leak or the stenosis, was evaluated. Complications related to stenting were also reported. Five procedures were included to treat 2 staple line leaks and 3 stenoses. Two types of stents were used, including a fully covered self-expandable metal stent designed for the SG anatomy (Hanarostent, ECBB-30-240-090; M.I. Tech, Co., Ltd, Seoul, South Korea) in 4 procedures and a biodegradable stent (BD stent 019-10A-25/20/25-080, SX-ELLA, Hradec Kralove, Czech Republic) in the remaining procedure. In all cases, an overtube was advanced with the endoscope through the SG to the duodenum. After placement of the guidewire and removal of the endoscope, the stent was easily advanced through the overtube. The overtube was pulled back and the stent was successfully deployed under fluoroscopic guidance. Technical success was achieved in all patients. The adoption of a modified technique of deployment of OTW stents using an overtube may represent an effective option in the approach of SG complications.

  19. Lower fetuin-A, retinol binding protein 4 and several metabolites after gastric bypass compared to sleeve gastrectomy in patients with type 2 diabetes.

    Directory of Open Access Journals (Sweden)

    Mia Jüllig

    Full Text Available BACKGROUND: Bypass of foregut secreted factors promoting insulin resistance is hypothesized to be one of the mechanisms by which resolution of type 2 diabetes (T2D follows roux-en-y gastric bypass (GBP surgery. AIM: To identify insulin resistance-associated proteins and metabolites which decrease more after GBP than after sleeve gastrectomy (SG prior to diabetes remission. METHODS: Fasting plasma from 15 subjects with T2D undergoing GBP or SG was analyzed by proteomic and metabolomic methods 3 days before and 3 days after surgery. Subjects were matched for age, BMI, metformin therapy and glycemic control. Insulin resistance was calculated using homeostasis model assessment (HOMA-IR. For proteomics, samples were depleted of abundant plasma proteins, digested with trypsin and labeled with iTRAQ isobaric tags prior to liquid chromatography-tandem mass spectrometry analysis. Metabolomic analysis was performed using gas chromatography-mass spectrometry. The effect of the respective bariatric surgery on identified proteins and metabolites was evaluated using two-way analysis of variance and appropriate post-hoc tests. RESULTS: HOMA-IR improved, albeit not significantly, in both groups after surgery. Proteomic analysis yielded seven proteins which decreased significantly after GBP only, including Fetuin-A and Retinol binding protein 4, both previously linked to insulin resistance. Significant decrease in Fetuin-A and Retinol binding protein 4 after GBP was confirmed using ELISA and immunoassay. Metabolomic analysis identified significant decrease of citrate, proline, histidine and decanoic acid specifically after GBP. CONCLUSION: Greater early decrease was seen for Fetuin-A, Retinol binding protein 4, and several metabolites after GBP compared to SG, preceding significant weight loss. This may contribute to enhanced T2D remission observed following foregut bypass procedures.

  20. Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass is Effective for Gastro-Oesophageal Reflux Disease but not for Further Weight Loss.

    Science.gov (United States)

    Parmar, Chetan D; Mahawar, Kamal K; Boyle, Maureen; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2017-07-01

    Inadequate weight loss (IWL)/weight regain (WR) and gastro-esophageal reflux disease (GERD), unresponsive to medical management, are two most common indications for conversion of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB). This study reports detailed outcomes of conversion of SG to RYGB for these two indications separately. We interrogated our prospectively maintained database to identify patients who underwent a conversion of their SG to RYGB in our unit. Outcomes in patients converted for IWL/WR and those converted for GERD were evaluated separately. We carried out 22 SG to RYGB in our unit between Aug 2012 and April 2015 with a mean follow-up of 16 months. Indication for conversion was GERD in 10/22 (45.5%) patients and IWL/WR in 11/22 (50.0%) patients. Patients undergoing conversion for GERD were significantly lighter (BMI 30.5) than those converted for IWL/WR (BMI 43.3) at the time of conversion. The conversion was very effective for GERD with 100% patients reporting improvement in symptoms, and 80% patients were able to stop their antacid medications. IWL/WR group achieved a further BMI drop of 2.5 points 2 years after surgery (final BMI 40.8) in comparison with 2.0 points BMI drop achieved by the GERD group (final BMI 28.5). This study demonstrates that conversion of SG to RYGB is effective for GERD symptoms but not for further weight loss, which was modest in both groups. Future studies need to examine the best revisional procedure for IWL/WR after SG.

  1. Laparoscopic Sleeve Gastrectomy for Mildly Obese Patients (Body Mass Index of 30 <35 kg/m2: Operative Outcome and Short-Term Results

    Directory of Open Access Journals (Sweden)

    Roger Noun

    2012-01-01

    Full Text Available Background. Data concerning laparoscopic sleeve gastrectomy (LSG in mild obesity are under investigation. Aim/Objective. May 2010 to May 2012, 122 consecutive patients with preoperative body mass index (BMI of 33±2.5 kg/m2 (range 30–34.9 undergoing LSG were studied. Mean age was 33±10 years (range 15–60, and 105 (86% were women. Mean preoperative weight was 91±9.7 kg (range 66–121, and preoperative excess weight was 30±6.7 kg (range 19–43. Comorbidities were detected in 44 (36% patients. Results. Mean operative time was 58±15 min (range 40–95, and postoperative stay was 1.8±0.19 days (range 1.5–3. There were no admissions to intensive care unit and no deaths within 30 days of surgery. The rates of leaks and strictures were 0%, and of hemorrhage 1.6%. At 12 months, BMI decreased to 24.7±2, and the percentage of excess weight loss (% EWL reached 76.5%. None of the patients had a BMI below 20 kg/m2. Comorbidities resolved in 70.5% or improved in 29.5%. Patient satisfaction scoring (1–5 at least 1 year after was 4.6±0.8 for body image and 4.4±0.6 for food tolerance. Conclusion. LSG for mildly obese patients has proved to be technically relatively easy, safe, and benefic in the short term.

  2. Quality of Life 1 Year After Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass: a Randomized Controlled Trial Focusing on Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Biter, L Ulas; van Buuren, Michiel M A; Mannaerts, Guido H H; Apers, Jan A; Dunkelgrün, Martin; Vijgen, Guy H E J

    2017-10-01

    Bariatric surgery is the only treatment option that achieves sustained weight loss in obese patients and that also has positive effects on obesity-related comorbidities. Laparoscopic sleeve gastrectomy (LSG) seems to achieve equal weight loss as laparoscopic Roux-en-Y gastric bypass (LRYGB), but there is still much debate about the quality of life (QOL) after LSG, mainly concerning the association with gastroesophageal reflux. Our hypothesis is that QOL after LSG is comparable with QOL after LRYGB. Between February 2013 and February 2014, 150 patients were randomized to undergo either LSG or LRYGB in our clinic. Differences in QOL were compared between groups by using multiple QOL questionnaires at follow-up moments preoperatively and 2 and 12 months after surgery. After 12 months of follow-up, 128 patients had returned the questionnaires. Most QOL questionnaires showed significant improvement in scores between the preoperative moment and after 12 months of follow-up. The Gastroesophageal Reflux Disease Questionnaire (GerdQ) score deteriorated in the LSG group after 2 months, but recovered again after 12 months. After 2 months of follow-up, the mean GerdQ score was 6.95 ± 2.14 in the LSG group versus 5.50 ± 1.49 in the LRYGB group (p < 0.001). After 1 year, the mean GerdQ score was 6.63 ± 2.26 in the LSG group and 5.60 ± 1.07 in the LRYGB group (p = 0.001). This randomized controlled trial shows that patients who underwent LSG have significantly higher GerdQ scores at both 2 and 12 months postoperatively than patients who underwent LRYGB, whereas overall QOL did not differ significantly.

  3. Morphofunctional Changes After Sleeve Gastrectomy and Very Low Calorie Diet in an Animal Model of Non-Alcoholic Fatty Liver Disease.

    Science.gov (United States)

    Talavera-Urquijo, Eider; Rodríguez-Navarro, Sarai; Beisani, Marc; Salcedo-Allende, Maria Teresa; Chakkur, Aisha; Arús-Avilés, Marc; Cremades, Manel; Augustin, Salvador; Martell, María; Balibrea, José M

    2018-01-01

    Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease and is found in 70% of obese people. The evidence available to date suggests that bariatric surgery could be an effective treatment by reducing weight and also by improving metabolic complications in the long term. This work aimed to compare, in a diet-induced NAFLD animal model, the effect of both sleeve gastrectomy (SG) and very-low calorie diet (VLCD). Thirty-five Wistar rats were divided into control rats (n = 7) and obese rats fed a high-fat diet (HFD). After 10 weeks, the obese rats were subdivided into four groups: HFD (n = 7), VLCD (n = 7), and rats submitted to either a sham operation (n = 7) or SG (n = 7). Both liver tissue and blood samples were processed to evaluate steatosis and NASH changes in histology (Oil Red, Sirius Red and H&E); presence of endothelial damage (CD31, Moesin/p-Moesin, Akt/p-Akt, eNOS/p-eNOS), oxidative stress (iNOS) and fibrosis (αSMA, Col1, PDGF, VEGF) proteins in liver tissue; and inflammatory (IL6, IL10, MCP-1, IL17α, TNFα), liver biochemical function, and hormonal (leptin, ghrelin, visfatin and insulin) alterations in plasma. Both VLCD and SG improved histology, but only SG induced a significant weight loss, improved endothelial damage, and a decreased cardiovascular risk by reducing insulin resistance (IR), leptin, total cholesterol, and triglyceride levels. There were no relevant variations in the inflammatory and fibrosis markers. Our study suggests a slight superiority of SG over VLCD by improving not only the histology but also the IR and cardiovascular risk markers related to NAFLD.

  4. Effects of sleeve gastrectomy and ileal transposition, alone and in combination, on food intake, body weight, gut hormones, and glucose metabolism in rats.

    Science.gov (United States)

    Nausheen, S; Shah, I H; Pezeshki, A; Sigalet, D L; Chelikani, P K

    2013-08-15

    Bariatric surgeries are hypothesized to produce weight loss and improve diabetes control by multiple mechanisms including gastric restriction and lower gut stimulation; the relative importance of these mechanisms remains poorly understood. We compared the effects of a typical foregut procedure, sleeve gastrectomy, (SG) with a primarily hindgut surgery, ileal transposition (IT), alone and together (SGIT), or sham manipulations, on food intake, body weight, gut hormones, glucose tolerance, and key markers of glucose homeostasis in peripheral tissues of adult male Sprague-Dawley rats (450-550 g, n = 7-9/group). SG, IT, and SGIT surgeries produced transient reduction in food intake and weight gain; the effects of SG and IT on intake and body weight were nonadditive. SG, IT, and SGIT surgeries resulted in increased tissue expression and plasma concentrations of the lower gut hormones glucagon-like peptide-1 and peptide YY and decreased plasma glucose-dependent insulinotropic peptide, insulin, and leptin concentrations. Despite transient effects on intake and weight gain, the SG, IT, and SGIT surgeries produced a significant improvement in glucose tolerance. In support of glycemic improvements, the protein abundance of key markers of glucose metabolism (e.g., GLUT4, PKA, IRS-1) in muscle and adipose tissue were increased, whereas the expression of key gluconeogenic enzyme in liver (G-6-Pase) were decreased following the surgeries. Therefore, our data suggest that enhanced lower gut stimulation following SG, IT, and SGIT surgeries leads to transient reduction in food intake and weight gain together with enhanced secretion of lower gut hormones and improved glucose clearance by peripheral tissues.

  5. Remodeling of the residual gastric mucosa after roux-en-y gastric bypass or vertical sleeve gastrectomy in diet-induced obese rats.

    Directory of Open Access Journals (Sweden)

    Konstantinos Arapis

    Full Text Available Whereas the remodeling of intestinal mucosa after bariatric surgeries has been the matter of numerous studies to our knowledge, very few reported on the remodeling of the residual gastric mucosa. In this study, we analyzed remodeling of gastric mucosa after Roux-en-Y gastric bypass (RYGB and vertical sleeve gastrectomy (VSG in rats. Diet-induced obese rats were subjected to RYGB, VSG or sham surgical procedures. All animals were assessed for food intake, body-weight, fasting blood, metabolites and hormones profiling, as well as insulin and glucose tolerance tests before and up to 5 weeks post-surgery. Remodeling of gastric tissues was analyzed by routine histology and immunohistochemistry studies, and qRT-PCR analyses of ghrelin and gastrin mRNA levels. In obese rats with impaired glucose tolerance, VSG and RYGB caused substantial weight loss and rats greatly improved their oral glucose tolerance. The remaining gastric mucosa after VSG and gastric pouch (GP after RYGB revealed a hyperplasia of the mucous neck cells that displayed a strong immunoreactivity for parietal cell H+/K+-ATPase. Ghrelin mRNA levels were reduced by 2-fold in remaining fundic mucosa after VSG and 10-fold in GP after RYGB. In the antrum, gastrin mRNA levels were reduced after VSG in line with the reduced number of gastrin positive cells. This study reports novel and important observations dealing with the remaining gastric mucosa after RYGB and VSG. The data demonstrate, for the first time, a hyperplasia of the mucous neck cells, a transit cell population of the stomach bearing differentiating capacities into zymogenic and peptic cells.

  6. Effect of Bariatric Sleeve Gastrectomy Technique on Women’s Lower Urinary Tract Symptoms and Quality of Life: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Fatih Uruç

    2016-09-01

    Full Text Available Objective Obesity triggers lower urinary tract symptoms (LUTS secondary to accumulation of excess fat which may lead to increase in intra-abdominal/intravesical pressures and subsequent impairment in pelvic floor muscles. However, it is considered that weight loss resolve these symptoms. In this study, we aimed to investigate the effects of bariatric surgery and especially Sleeve gastrectomy (SG on women’s LUTS, and quality of life. Materials and Methods A total of 53 patients who have undergone laparoscopic SG in our clinics between April 2014 and March 2015 were included in this prospective study. Age, body weight and body mass index (BMI of the participants were preoperatively and postoperatively recorded. The patients have pre/post-operatively filled the Beck depression inventory (BDI, International prostate symptom score (IPSS, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF and the 36-Item Short Form health survey (SF-36 scores were recorded. Additionally, post-operative decrease in body weight and BMI of the patients was recorded. Results There was a statistically significant decrease in mean BDI, IPSS and ICIQ-SF scores and SF-36 (prominent increment in physical and mental component summary (PCS and MCS scores, when compared with pre-operative values. A positive correlation was found between BMI and parameters including age, BDI and IPSS. However, no significant correlation was present between BMI and the parameters including ICIQ-SF, PCS and MCS. Conclusion Negative effect of obesity on LUTS and quality of life cannot be ignored. We assume that bariatric surgery can induce dramatic weight loss, amelioration in symptoms of urinary dysfunction and increase in quality of life of women.

  7. Efficacy and Safety of the Over-the-Scope Clip (OTSC) System in the Management of Leak and Fistula After Laparoscopic Sleeve Gastrectomy: a Systematic Review.

    Science.gov (United States)

    Shoar, Saeed; Poliakin, Lauren; Khorgami, Zhamak; Rubenstein, Rebecca; El-Matbouly, Moamena; Levin, Jun L; Saber, Alan A

    2017-09-01

    Endoscopic management of leaks/fistulas after laparoscopic sleeve gastrectomy (LSG) is gaining popularity in the bariatric surgery. This study aimed to review the efficacy and safety of over-the-scope-clip (OTSC) system in endoscopic closure of post-LSG leak/fistula. PubMed/Medline and major journals of the field were systematically reviewed for studies on endoscopic closure of post-LSG leaks/fistula by means of the OTSC system. A total of ten eligible studies including 195 patients with post-LSG leaks/fistula were identified. The time between LSG and leak/fistula ranged from 1 day to 803 days. Most of the leaks/fistula were located at the proximal staple line, and they sized from 3 to 20 mm. Time between leak diagnosis and OTSC clipping ranged from 0 to 271 days. Thirty-three out of 53 patients (63.5%) required one clip for closure of the lesion. Regarding the OTSC-related complications, a leak occurred in five patients (9.3%) and OTSC migration, stenosis, and tear each in one patient (1.8%). Of the 73 patients with post-LSG leak treated with OTSC, 63 patients had an overall successful closure (86.3%). OTSC system is a promising endoscopic approach for management of post-LSG leaks in appropriately selected patients. Unfortunately, most studies are series with a small sample size, short-term follow-up, and mixed data of concomitant procedures with OTSC. Further studies should distinguish the net efficacy of the OTSC system from other concomitant procedures in treatment of post-LSG leak.

  8. Comparing Outcomes of Two Types of Bariatric Surgery in an Adolescent Obese Population: Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Giovana D Maffazioli

    2016-07-01

    Full Text Available Background: Obesity is prevalent among adolescents and is associated with serious health consequences. Roux-en-Y Gastric Bypass (RYGB and Sleeve Gastrectomy (SG are bariatric procedures that cause significant weight loss in adults and are increasingly being performed in adolescents with morbid obesity. Data comparing outcomes of RYGB versus SG in this age-group are scarce. This study aims to compare short-term (1-6 months and longer-term (7-18 months body mass index (BMI and biochemical outcomes following RYGB and SG in adolescents/young adults.Methods: A retrospective study using data extracted from medical records of patients 16-21 years who underwent RYGB or SG between 2012-2014 at a tertiary care academic medical center. Results: Forty-six patients were included in this study: 24 underwent RYGB and 22 underwent SG. Groups did not differ for baseline age, sex, race or BMI. BMI reductions were significant at 1-6 months and 7-18 months within groups (p<0.0001, but did not differ by surgery type (p= 0.65 and 0.09, for 1-6 months and 7-18 months, respectively. Over 7-18 months, within-group improvement in low density lipoprotein (LDL (-24±6 in RYGB, p=0.003, vs. -7±9mg/dL in SG, p=0.50 and non-high density lipoprotein (non-HDL cholesterol (-23±8 in RYGB, p=0.02, vs. -12±7 in SG, p=0.18 appeared to be of greater magnitude following RYGB. However, differences between groups did not reach statistical significance. When divided by non-alcoholic steatohepatitis stages (NASH, patients with Stage II-III NASH had greater reductions in ALT levels vs. those with Stage 0-I NASH (-45±18 vs -9±3, p=0.01 after 7-18 months. RYGB and SG groups did not differ for the magnitude of post-surgical changes in liver enzymes. Conclusion: RYGB and SG did not differ for the magnitude of BMI reduction across groups, though changes trended higher following RYGB. Further prospective studies are needed to confirm these findings.

  9. Cardiovascular Risk Factors After Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): a New Effective Therapeutic Approach?

    Science.gov (United States)

    Torres, Antonio; Rubio, Miguel A; Ramos-Leví, Ana M; Sánchez-Pernaute, Andrés

    2017-11-07

    Obesity and its associated comorbidities entail a significantly increased cardiovascular mortality. Therefore, approaching obesity control must include among its aims the reduction of the associated comorbidities and the higher cardiovascular mortality risk and not only weight loss. Many observational studies indicate that bariatric surgery (BS) is associated with a better long-term survival than standard care. Furthermore, in general, these epidemiological studies included patients who underwent gastric bypass (GB), not biliopancreatic diversion/duodenal switch (BPD/DS), so the potential additional benefit of this latter technique remains unknown. In this regard, in theory, derivative techniques are usually associated to a higher rate of long-term improvement of metabolic comorbidities, so their potential impact on cardiovascular morbidity and mortality could be even greater than what has been published up to date. In 2007, our group proposed a simplification of the bariatric technique based on the duodenal switch, which we termed "single anastomosis duodeno-ileal bypass with sleeve gastrectomy" or SADI-S. In this review, and 10 years later, we describe some of the main results of those patients who underwent this procedure, specifically regarding their outcome on metabolic comorbidities and cardiovascular risk. Considering the findings presented in this review, in which a significant improvement of all metabolic comorbidities was observed, we may confidently suggest that SADI-S seems comparable to a BPD/DS procedure in the mid-term outcome. After all, the SADI-S procedure was conceived as a simplified version of the BPD/DS technique and not necessarily intended to maximize the improvement of cardiovascular and metabolic comorbidities, which is already sufficiently optimal. In this regard, in our experience, we have encountered a new satisfactory result, which combines more pros than cons. In fact, as we have seen, after a follow-up of 3 years, the outcomes of

  10. C-reactive protein, fibrinogen, and procalcitonin levels as early markers of staple line leak after laparoscopic sleeve gastrectomy in morbidly obese patients within an Enhanced Recovery After Surgery (ERAS) program.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Muñoz, Jose Luis; Gonzalez, Juan; Garcia, Alejandro; Ferrigni, Carlos; Jimenez, Montiel; Duran, Manuel

    2017-12-01

    The performance of most bariatric procedures within an Enhanced Recovery After Surgery program has resulted in significant advantages, including a reduction in the length of hospital stay to 2-3 days. However, some postoperative complications may appear after the patient has been discharged. The aim of this study was to investigate the efficacy of various acute-phase parameters determined 24 h after a laparoscopic sleeve gastrectomy for predicting staple line leak in the postoperative course. A prospective study of 208 morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between 2012 and 2015 was performed. Blood analysis was performed 24 h after surgery. Acute-phase parameters (C-reactive protein, procalcitonin, fibrinogen, and White Blood Cell count) were investigated. Staple line leak appeared in eight patients (3.8%). Using receiver operating characteristic analysis at 24 h postoperatively, a cutoff level of CRP at 9 mg/dL achieved 85% sensitivity and 90% specificity for predicting staple line leak, a cutoff level of procalcitonin at 0.85 ng/mL achieved 70% sensitivity and 90% specificity, and a cutoff level of fibrinogen at 600 mg/dL achieved 80% sensitivity and 87.5% specificity. An elevation of CRP > 9 mg/dL, procalcitonin > 0.85 ng/mL and fibrinogen > 600 mg/dL should alert the surgeon the possibility of occurrence of postoperative staple line leak.

  11. Serum concentrations and subcutaneous adipose tissue mRNA expression of omentin in morbid obesity and type 2 diabetes mellitus: the effect of very-low-calorie diet, physical activity and laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Urbanová, M; Dostálová, I; Trachta, P; Drápalová, J; Kaválková, P; Haluzíková, D; Matoulek, M; Lacinová, Z; Mráz, M; Kasalický, M; Haluzík, M

    2014-01-01

    Omentin is a novel adipokine with insulin-sensitizing effects expressed predominantly in visceral fat. We investigated serum omentin levels and its mRNA expression in subcutaneous adipose tissue (SCAT) of 11 women with type 2 diabetes mellitus (T2DM), 37 obese non-diabetic women (OB) and 26 healthy lean women (C) before and after various weight loss interventions: 2-week very-low-calorie diet (VLCD), 3-month regular exercise and laparoscopic sleeve gastrectomy (LSG). At baseline, both T2DM and OB groups had decreased serum omentin concentrations compared with C group while omentin mRNA expression in SCAT did not significantly differ among the groups. Neither VLCD nor exercise significantly affected serum omentin concentrations and its mRNA expression in SCAT of OB or T2DM group. LSG significantly increased serum omentin levels in OB group. In contrast, omentin mRNA expression in SCAT was significantly reduced after LSG. Baseline fasting serum omentin levels in a combined group of the studied subjects (C, OB, T2DM) negatively correlated with BMI, CRP, insulin, LDL-cholesterol, triglycerides and leptin and were positively related to HDL-cholesterol. Reduced circulating omentin levels could play a role in the etiopathogenesis of obesity and T2DM. The increase in circulating omentin levels and the decrease in omentin mRNA expression in SCAT of obese women after LSG might contribute to surgery-induced metabolic improvements and sustained reduction of body weight.

  12. The Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Surgery on Dietary Intake, Food Preferences, and Gastrointestinal Symptoms in Post-Surgical Morbidly Obese Lebanese Subjects: A Cross-Sectional Pilot Study.

    Science.gov (United States)

    El Labban, Sibelle; Safadi, Bassem; Olabi, Ammar

    2015-12-01

    Data on gastrointestinal (GI) and dietary changes following bariatric surgery are scarce in the Middle Eastern region. The objective of this work was to retrospectively compare dietary intake, food preferences, and GI symptoms in subjects with extreme obesity after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Sixty subjects equally divided between RYGB and SG with a postoperative period of ≥6 months were recruited for a retrospective, non-randomized, and observational study. All subjects completed three questionnaires (GI symptoms, food preferences, and quantitative food frequency questionnaire (FFQ)) and three 24-h recalls. At one year postoperatively, both surgical groups showed similar percentage of excess weight loss that exceeded 50%. In addition, percentage of carbohydrate, protein, and sugar intake from total energy, frequency of daily consumption from the eight food categories and daily energy intake were comparable between surgical groups. RYGB subjects consumed significantly more fruits and juices from total energy (P fast heartbeat (P food preferences between RYGB and SG groups. There was a trend for sweet-eating in SG subjects with less dumping symptoms to suggest different mechanisms of action for each procedure, which might impact eating behavior.

  13. Preoperative Regular Diet of 900 kcal/day vs Balanced Energy High-Protein Formula vs Immunonutrition Formula: Effect on Preoperative Weight Loss and Postoperative Pain, Complications and Analytical Acute Phase Reactants After Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Zubiaga, Lorea; Diez, Maria; Murcia, Ana; Boix, Evangelina; Muñoz, José Luis; Llavero, Carolina

    2016-06-01

    Between 2 and 8 weeks before surgery, most bariatric surgery groups establish strict dietary treatments with a total caloric intake of less than 1,000 kcal/day in order to maximize weight loss during this period of time. A prospective randomized clinical trial of all the patients undergoing laparoscopic sleeve gastrectomy (LSG) was performed. Patients were randomly assigned into 3 groups: those patients receiving a preoperative regular diet of 900 kcal/day (group 1), those receiving a preoperative balanced energy high-protein formula (group 2) and those receiving preoperative Immunonutrition (group 3). Preoperative weight loss, postoperative pain, complications and analytical acute phase reactants were investigated. Sixty patients were included in the study, 20 in each group. Preoperative excess weight loss was 7.7 % in group 1, 12.3 % in group 2 and 15.3 % in group 3 (p = 0.014). Median postoperative pain was 3.5 in group 1, 3 in group 2 and 2 in group 3 (p = 0.048). C-reactive protein determined 24 h after surgery was significantly lower in group 3 than in the other groups. AST and ALT values were significantly lower in group 3 than in the other groups, without significant differences between groups 1 and 2. Preoperative diet with Immunonutrition formulas during 2 weeks achieves a greater preoperative weight loss, lower postoperative pain and lower values of CRP and liver enzymes than high-protein formulas or regular diet, all of them with similar caloric intake.

  14. C-Reactive Protein and Procalcitonin as Early Markers of Septic Complications after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients Within an Enhanced Recovery After Surgery Program.

    Science.gov (United States)

    Muñoz, José Luis; Ruiz-Tovar, Jaime; Miranda, Elena; Berrio, Diana Lorena; Moya, Pedro; Gutiérrez, Manuel; Flores, Raquel; Picó, Carlos; Pérez, Ana

    2016-05-01

    The performance of most bariatric procedures within an Enhanced Recovery After Surgery (ERAS) programs has resulted in considerable advantages, including a reduction in the length of hospital stay to 2 to 3 days. However, some postoperative complications can appear after the patient has been discharged. The aim of this study was to investigate the efficacy of various acute-phase parameters determined 24 and 48 hours after laparoscopic sleeve gastrectomy (LSG) as bariatric procedure, for predicting septic complications, such a surgical site infection (SSI), in the postoperative course. A prospective study of 115 morbidly obese patients who underwent LSG within an ERAS program between 2012 and 2015 was conducted. Blood analysis was performed 24 and 48 hours after surgery. Acute-phase parameters (C-reactive protein [CRP], procalcitonin, and fibrinogen) and WBC count were investigated. Septic complications were observed in 13 patients (11.3%). Using receiver operating characteristic analysis at 24 hours postoperatively, a cutoff level of CRP at 70 mg/L achieved 85% sensitivity and 90% specificity for predicting SSI, and a cutoff level of procalcitonin at 0.2 ng/mL achieved 70% sensitivity and 90% specificity. At 48 hours postoperatively, a cutoff level of CRP at 150 mg/L and procalcitonin at 0.95 ng/mL achieved 100% sensitivity and 100% specificity for predicting SSI. The use of CRP and procalcitonin in the first day and especially in the second day postoperative can predict septic complications after LSG. This is most useful for patients within an ERAS program who will be discharged early. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Gastric Sleeve Surgery

    Science.gov (United States)

    ... Videos for Educators Search English Español Gastric Sleeve Surgery KidsHealth / For Teens / Gastric Sleeve Surgery What's in ... or buying healthy food ) Preparing for Gastric Sleeve Surgery Preparing for this major operation takes months of ...

  16. Heat flux limiting sleeves

    Science.gov (United States)

    Harris, William G.

    1985-01-01

    A heat limiting tubular sleeve extending over only a portion of a tube having a generally uniform outside diameter, the sleeve being open on both ends, having one end thereof larger in diameter than the other end thereof and having a wall thickness which decreases in the same direction as the diameter of the sleeve decreases so that the heat transfer through the sleeve and tube is less adjacent the large diameter end of the sleeve than adjacent the other end thereof.

  17. The effects of sleeve gastectomy on gastro-esophageal reflux and gastro-esophageal motility.

    Science.gov (United States)

    Hayat, Jamal O; Wan, Andrew

    2014-05-01

    Sleeve gastrectomy is an increasingly performed bariatric procedure associated with low morbidity and good short to medium term effects on weight loss and comorbid conditions. Studies assessing the prevalence of post-operative gastro-esophageal reflux disease (GERD), show sleeve gastrectomy may provoke de novo GERD symptoms or worsening of pre-existing GERD. Pathophysiological mechanisms of GERD after sleeve gastrectomy include a hypotensive lower esophageal sphincter, increased gastro-esophageal pressure gradient and intra-thoracic migration of the remnant stomach. A reduction in the compliance of the gastric remnant may provoke an increase in transient lower esophageal sphincter relaxations. Time-resolved MRI suggests relative gastric stasis in the proximal remnant and increased emptying from the antrum. A lack of standardisation of technique, along with heterogeneity of studies assessing GERD may explain the wide variability in reported results. Simultaneous and careful repair of an associated hiatus hernia may result in a reduction in the prevalence of post-operative GERD.

  18. Extending service life of steam generators by sleeving tubes

    International Nuclear Information System (INIS)

    Gutzwiller, J.E.

    1982-01-01

    Steam generator tubes that are failing due to IGA in the tubesheet crevice can be kept in service by using the basic sealable sleeve design developed by BandW. Variations of the present sleeve design could significantly reduce the number of tubes that must be plugged each year. Sleeving had the potential of keeping 28 percent more tubes in service during 1979. Lowering the overall rate at which tubes are removed from service by plugging will reduce the probability of having to derate the plant or replace the steam generator. Considering tomorrow's replacement power costs, sleeving to keep tubes in service is a practical and sound investment

  19. Guide tube sleeve

    International Nuclear Information System (INIS)

    Attix, D.J.

    1983-01-01

    The invention increases the operating capacity of a nuclear reactor by causing a modification in the flow pattern of the coolant which enhances the coolant's effectiveness. The apparatus provides a thin-walled tubular sleeve closely surrounding but not attached to the exterior surface of a guide tube in a fuel assembly. The wall of the sleeve has tabs projecting outwardly into adjacent flow channels. The sleeve is attached to the wall of a cellular void through which passes the guide tube associated with said sleeve. The tabs increase the flow of water in the channel and thus increase the heat transfer

  20. Aspectos técnicos da interposição ileal com gastrectomia vertical como possível opção ao tratamento do diabetes mellitus tipo 2 Technical aspects of ileal interposition with sleeve gastrectomy as a possible option for the treatment of type 2

    Directory of Open Access Journals (Sweden)

    Aureo Ludovico de Paula

    2010-06-01

    mortalidade, factível cirurgicamente pela via laparoscópica e passível de ser ofertada como opção operatória ao tratamento da diabetes mellitus tipo 2.INTRODUCTION: There is an evidence that the best results in terms of resolution of diabetes in morbidly obese patients are achieved with bilio-pancreatic bypass, especially the duodenal switch. These operations are characterized by partial gastrectomy and the rapid transit of food into the distal ileum through derivation of a significant segment of small intestine. The idea of performing the technique presented here was based on these principles. METHOD: The procedures are usually performed laparoscopically, after establishment of a pneumoperitoneum at 12-15 mmHg and introduction of six trocars. The patient is initially positioned in 30° reverse Trendelenburg with the surgeon on the right side of the patient. The sleeve gastrectomy is performed using the anatomical distal trifurcation of the anterior vagus nerve as a reference. The devascularization of the greater curvature is performed and extends to the oesophagogastric junction. With an intra-gastric calibration tube of 20 mm positioned along the lesser curvature, gastric resection starts at the proximal antrum with linear stapler up to oesophagogastric angle. An invaginating running suture is also performed. To perform the ileal interposition in the proximal jejunum, it is divided 20-30 cm distally with a 45-mm linear stapler. The cecum is identified and the distal ileum transected 30cm proximal to the ileocecal valve. A 170 to 200 cm of ileum was measured proximally along the anti-mesenteric border using a 10-cm marked atraumatic grasper, and transected with a 45-mm linear stapler. This segment of ileum is interposed in an isoperistaltic way into the proximal jejunum, previously divided. Next are perform three side-to-side enteroanastomosis. The first enteroanastomosis is the ileo-ileostomy, then the jejuno-ileostomy and finally, the ileo-jejunostomy. All three

  1. Grid sleeve bulge tool

    International Nuclear Information System (INIS)

    Phillips, W.D.; Vaill, R.E.

    1980-01-01

    An improved grid sleeve bulge tool is designed for securing control rod guide tubes to sleeves brazed in a fuel assembly grid. The tool includes a cylinder having an outer diameter less than the internal diameter of the control rod guide tubes. The walls of the cylinder are cut in an axial direction along its length to provide several flexible tines or ligaments. These tines are similar to a fork except they are spaced in a circumferential direction. The end of each alternate tine is equipped with a semispherical projection which extends radially outwardly from the tine surface. A ram or plunger of generally cylindrical configuration and about the same length as the cylinder is designed to fit in and move axially of the cylinder and thereby force the tined projections outwardly when the ram is pulled into the cylinder. The ram surface includes axially extending grooves and plane surfaces which are complimentary to the inner surfaces formed on the tines on the cylinder. As the cylinder is inserted into a control rod guide tube, and the projections on the cylinder placed in a position just below or above a grid strap, the ram is pulled into the cylinder, thus moving the tines and the projections thereon outwardly into contact with the sleeve, to plastically deform both the sleeve and the control rod guide tube, and thereby form four bulges which extend outwardly from the sleeve surface and beyond the outer periphery of the grid peripheral strap. This process is then repeated at the points above the grid to also provide for outwardly projecting surfaces, the result being that the grid is accurately positioned on and mechanically secured to the control rod guide tubes which extend the length of a fuel assembly

  2. Storage envelopes or sleeves

    International Nuclear Information System (INIS)

    Freshwater, J.R.; Wagman, P.I.

    1980-01-01

    A storage envelope or sleeve particularly for processed X-ray films is described. It consists of front and back panels joined together at a hinge line and connected along the intermediate sides by connecting flaps. An inner pocket is formed from a third flap which is folded to lie against the inner face of the back panel. The panels may have additional score lines parallel to the closed sides of the envelope and the inner pocket so that the envelope and the inner pocket can accommodate bulky contents. The free edge of the pocket is inset from the open side of the envelope, and finger cut-outs may be provided to facilitate access to the contents of the envelope and the pocket. (author)

  3. Radiological findings after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Riedl, P.; Polterauer, P.; Funovics, J.

    1980-06-01

    In 63 patients after total gastrectomy and reconstruction of the small bowel described by Beal-Longmire, Roux and Tomoda radiological findings were correlated with clinical symptoms. No correlation could be found between clinical symptoms of dumping and oesophagitis caused by reflux on one side and increased length of intestinal transit time, increased diameter of intestinal loops and gastro-oesophageal reflux on the other side. Enlarged blind loops after termino-lateral oesophago-jejunostomy and insufficient ligations (operation technique by Tomoda) were correlated with higher incidence of pains. Patients operated by the method of Beal-Longmire and Roux showed better results than those operated with the method of Tomoda.

  4. Sleeving repair of heat exchanger tubes

    International Nuclear Information System (INIS)

    Street, Michael D.; Schafer, Bruce W.

    2000-01-01

    Defective heat exchanger tubes can be repaired using techniques that do not involve the cost and schedule penalties of component replacement. FTI's years of experience repairing steam generator tubes have been successfully applied to heat exchangers. Framatome Technologies heat exchanger sleeves can bridge defective areas of the heat exchanger tubes, sleeves have been designed to repair typical heat exchanger tube defects caused by excessive tube vibration, stress corrosion cracking, pitting or erosion. By installing a sleeve, the majority of the tube's heat transfer and flow capacity is maintained and the need to replace the heat exchanger can be delayed or eliminated. Both performance and reliability are improved. FTI typically installs heat exchanger tube sleeves using either a roll expansion or hydraulic expansion process. While roll expansion of a sleeve can be accomplished very quickly, hydraulic expansion allows sleeves to be installed deep within a tube where a roll expander cannot reach. Benefits of FTI's heat exchanger tube sleeving techniques include: - Sleeves can be positioned any where along the tube length, and for precise positioning of the sleeve eddy current techniques can be employed. - Varying sleeve lengths can be used. - Both the roll and hydraulic expansion processes are rapid and both produce joints that do not require stress relief. - Because of low leak rates and speed of installations, sleeves can be used to preventatively repair likely-to-fail tubes. - Sleeves can be used for tube stiffening and to limit leakage through tube defects. - Because of installation speed, there is minimal impact on outage schedules and budgets. FTI's recently installed heat exchanger sleeving at the Kori-3 Nuclear Power Station in conjunction with Korea Plant Service and Engineering Co., Ltd. The sleeves were installed in the 3A and 3B component cooling water heat exchangers. A total of 859 tubesheet and 68 freespan sleeves were installed in the 3A heat

  5. Intrathoracic Hernia after Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Yoshihiko Tashiro

    2016-05-01

    Full Text Available Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.

  6. Root cause analysis of thermal sleeve separation

    Energy Technology Data Exchange (ETDEWEB)

    Jo, J. C.; Jhung, M. J.; Yu, S. O.; Kim, H. J.; Yune, Y. K.; Park, J. Y

    2006-01-15

    Thermal sleeves in the shape of thin wall cylinder seated inside the nozzle part of each Safety Injection (SI) line at Pressurized Water Reactors (PWRs) have such functions as prevention and relief of potential excessive transient thermal stress in the wall of SI line nozzle part which is initially heated up with hot water flowing in the primary coolant piping system when cold water is injected into the system through the SI nozzles during the SI operation mode. Recently, mechanical failures that the sleeves were separated from the SI branch pipe and fell into the connected cold leg main pipe occurred in sequence at some typical PWR plants in Korea. To find out the root cause of thermal sleeve breakaway failures, the flow situation in the junction of primary coolant main pipe and SI branch pipe, and the vibration modal characteristics of the thermal sleeve are investigated in detail by using both Computational Fluid Dynamic (CFD) code and structure analysis finite element code. As the results, the transient response in fluid force exerting on the local part of thermal sleeve wall surface to the primary coolant flow through the pipe junction area during the normal reactor operation mode shows oscillatory characteristics with frequencies ranging from 17 to 18, which coincide with one of the lower mode natural frequencies of thermal sleeve having a pinned support condition on the circumferential prominence on the outer surface of thermal sleeve which is put into the circumferential groove on the inner surface of SI nozzle at the mid-height of the thermal sleeve. In addition, the variation of force on the thermal sleeve surface yields alternating torques in the directions of two rectangular axes which are perpendicular to the longitudinal axis of cylindrical thermal sleeve, which cause rolling, pitching and rotating motions of the thermal sleeve. Consequently, it is seen that this flow situation surrounding the thermal sleeve during the normal reactor operation can

  7. Total gastrectomy for non-neoplastic diseases

    DEFF Research Database (Denmark)

    Bjorn, Niels; Ainsworth, Alan Patrick; Mortensen, Michael Bau

    2017-01-01

    Background: The aim of this study was to describe patients who had total gastrectomy for non-neoplastic diseases within a well-defined geographical area. Material and Methods: Retrospective study of patients who had gastrectomy for a non-neoplastic disease at the Department of Surgery, Odense...... University Hospital from 1 January 2005 to 31 December 2014. Results: A total of 268 gastrectomies were performed with the 10-year period. Of these, ten (4%) were done for non-neoplastic diseases. Two were men and eight women with a median age of 51 years (range 31 to 96 years). Six had emergency surgery...... of 10 and 2 of 10, respectively. Histology of the resected specimens showed: Oedema, inflammation and/or necrosis (n=6), Menetrier's disease (n=2) and perforation (n=2). Conclusions: Gastrectomy for non-neoplastic diseases accounts for less than 5% of all gastrectomies. The majority of these cases...

  8. Framatome technologies successfully performs SG re-sleeving at Kewaunee

    International Nuclear Information System (INIS)

    Anon.

    1997-01-01

    Framatome Technologies teamed with ABB-CE (Connecticut) to remove previously installed sleeves from the Kewaunee nuclear power stations steam generator tubes and install new sleeves. Recent inspections indicated problems at the upper joint of many of the previous sleeves. The process involved removing most of the hydraulic expansion joint (HEJ) sleeve, expanding the sleeve remnant and the tube section at the upper joint, and installing a TIG-welded sleeve that bridges the problem portion of the tube that the HEJ sleeve covered

  9. Steam generator thermal sleeve reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Caton, E.; Askari, A.; Volder, P. [Babcock and Wilcox Canada Ltd., Cambridge, Ontario (Canada)]. E-mail: eecaton@babcock.com

    2003-07-01

    'Full text:' Successful implementation of a physically difficult repair program requires collaboration of the design and construction functions of an organization to ensure that goals are shared and rework or on-the-fly design changes are not required. Furthermore, in a nuclear facility this collaboration results in the optimal safety condition as dose uptake is minimized with a well planned job. The replacement of the degraded thermal sleeves in the Pickering A Steam Generator feedwater nozzles posed this type of problem. The project may be summarized as follows: i) problem analysis, ii) identification of design parameters and limitations, iii) integration of field engineering and design engineering solutions, iv) installation. Integration of the design engineering and field engineering design parameters ensured that the most effective solution was implemented. (author)

  10. Process to repair a steam generator tube by inserting a tubular sleeve and the associated sleeve

    International Nuclear Information System (INIS)

    Gaudin, J.P.

    1986-01-01

    The tubular sleeve is introduced in the tube and is mechanically expanded inside the tube plate, and is diametrally expanded at its upper part within the tube and outside the tube plate. Tightness is ensured by brazing the end part of the sleeve within the tube. The end part of the sleeve is brazed by melting of brazing metal previously applied to the outer surface of the sleeve of its end region. The invention applies more particularly to steam generators of pressurized water nuclear reactors [fr

  11. Single port Billroth I gastrectomy

    Directory of Open Access Journals (Sweden)

    Jeremy R Huddy

    2013-01-01

    Full Text Available Introduction: Experience has allowed increasingly complex procedures to be undertaken by single port surgery. We describe a technique for single port Billroth I gastrectomy with a hand-sewn intracorporeal anastomosis in the resection of a benign tumour diagnosed incidentally on a background of cholelithiasis. Materials and Methods: Single port Billroth I gastrectomy and cholecystectomy was performed using a transumbilical quadport. Flexible tipped camera and straight conventional instruments were used throughout the procedure. The stomach was mobilised including a limited lymph node dissection and resection margins in the proximal antrum and duodenum were divided with a flexible tipped laparoscopic stapler. The lesser curve was reconstructed and an intracorporal hand sewn two layer end-to-end anastomosis was performed using unidirectional barbed sutures. Intraoperative endoscopy confirmed the anastomosis to be patent without leak. Results: Enteral feed was started on the day of surgery, increasing to a full diet by day 6. Analgesic requirements were a patient-controlled analgesia morphine pump for 4 postoperative days and paracetamol for 6 days. There were no postoperative complications and the patient was discharged on the eighth day. Histology confirmed gastric submucosal lipoma. Discussion: As technology improves more complex procedures are possible by single port laparoscopic surgery. In this case, flexible tipped cameras and unidirectional barbed sutures have facilitated an intracorporal hand-sewn two layer end-to-end anastomosis. Experience will allow such techniques to become mainstream.

  12. Parametric study for design of thermal sleeves

    International Nuclear Information System (INIS)

    Mukherjee, A.B.; Mehra, V.K.

    1985-01-01

    Thermal sleeves are used inside nozzle in many reactor components. Basic aim in design of thermal sleeve is to arrive at a set of dimensions for gap and annulus length, which will give rise to minimum thermal gradient in the base metal of the associated nozzle. Study includes the minimisation of the thermal gradient in the crotch zone by suitable choice of gap and annulus length. Three different geometries of nozzle radii 50.00 mm., 100 mm. and 200.0 mm. are studied for single and two concentric thermal sleeves model. The paper also presents effect of parameters like velocity of flow, temperature of fluid, materials etc. on the design of thermal sleeves. (orig.)

  13. Improvements in nuclear fuel assembly sleeves

    International Nuclear Information System (INIS)

    Eaton, C.W.; Seeley, T.A.; Ince, G.; Speakman, W.T.

    1986-01-01

    The graphite sleeve of a nuclear fuel assembly or reflector element for a stringer mounts a number of grids via mounting assemblies installed in grooves formed in the interior wall surface of the sleeve. The bore of the sleeve is of reduced cross-section between two successive grooves such that the internal diameter of the sleeve is substantially the same as the inner diameter of the radially innermost extremity of the mounting assemblies whereby the coolant pressure loss at each transition between the reduced diameter bore section and the mounting assemblies is reduced. Each mounting assembly may be of radially contractable split ring construction to permit its placement in the groove and may carry burnable poison material. (author)

  14. Improvements in nuclear fuel assembly sleeves

    Energy Technology Data Exchange (ETDEWEB)

    Eaton, C.W.; Seeley, T.A.; Ince, G.; Speakman, W.T.

    1986-02-26

    The graphite sleeve of a nuclear fuel assembly or reflector element for a stringer mounts a number of grids via mounting assemblies installed in grooves formed in the interior wall surface of the sleeve. The bore of the sleeve is of reduced cross-section between two successive grooves such that the internal diameter of the sleeve is substantially the same as the inner diameter of the radially innermost extremity of the mounting assemblies whereby the coolant pressure loss at each transition between the reduced diameter bore section and the mounting assemblies is reduced. Each mounting assembly may be of radially contractable split ring construction to permit its placement in the groove and may carry burnable poison material.

  15. Aphonia and dysphagia after gastrectomy.

    Science.gov (United States)

    Ozawa, Hiroyuki; Satako, Kimura; Mizutari, Kunio; Fujimine, Takekatsu; Fujii, Masato; Syunji, Ikeuchi; Matunaga, Tatsuo; Tsunoda, Koichi

    2005-11-01

    A 67-year-old male was referred to our otolaryngological clinic because of aphonia and dysphagia. His voice was breathy and he could not even swallow saliva following a total gastrectomy for gastric carcinoma performed 2 weeks previously. Laryngeal fiberscopy revealed major glottal incompetence when he tried to phonate. However, both vocal folds abducted over the full range during inhalation. The patient could not swallow saliva because of a huge glottal chink, even during phonation. Based on these findings, he was diagnosed as having bilateral incomplete cricoarytenoid dislocation after intubation. The patient underwent speech therapy; within 1 min his vocal fold movement recovered dramatically and he was able to phonate and swallow. There have been few case reports of bilateral cricoarytenoid dislocation, and no effective rehabilitation has been reported. We believe that our method of vocal rehabilitation serves as a useful reference for physicians and surgeons worldwide.

  16. Gastrectomy

    Science.gov (United States)

    ... to the intestine which can cause infection or abscess The connection to the intestine narrows, causing blockage ... Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also ...

  17. Getting the most from the sleeve: the importance of post-operative follow-up.

    Science.gov (United States)

    Keren, Dean; Matter, Ibrahim; Rainis, Tova; Lavy, Alexandra

    2011-12-01

    Bariatric approach to obesity provides substantial weight loss and comorbidity resolution. Our unique service includes pre- and postoperative visits to the Health and Nutrition Clinic headed by a specialist in gastroenterology and nutrition. We compared patients attending regular clinic routine with those who were lost to follow-up with regard to anthropometry, comorbidity, quality of life, and food tolerance and determined who benefited most from the operation. A retrospective review was performed on patients 30 months after undergoing sleeve gastrectomy. Body mass index was used to report weight loss. Bariatric Analysis and Reporting Outcome System (BAROS) and Food Tolerance Score were (FTS) completed by all patients at the 30-month follow-up visit and compared between two groups (group I-30 months of active postoperative follow-up; group II-without). A total of 119 patients participated in the study. For groups I and II, the mean percentage of excess BMI loss at 30 months was 82.08 ± 9.83 and 74.88 ± 8.75, respectively, with better comorbidity improvement in group I. BAROS scores were 7.62 ± 0.72 and 6.92 ± 0.92. FTS was 24.30 ± 2.09 and 22.55 ± 2.27, respectively. From our experience, getting the most from the sleeve is attributed to two main factors: surgery and nutrition. Surgery results in optimal restriction and improved satiety, whereas nutrition relies on a professional medical team providing constant, ongoing patient support throughout all the bariatric process stages. These teams of surgeons and gastroenterologists specializing in nutrition, working side by side, each in their area of specialty, are the main pillars leading to the success of the sleeve.

  18. Prevalence of Non-Alcoholic Fatty Liver Disease in Morbidly Obese Patients Undergoing Sleeve Bariatric Surgery in Iran and Association With Other Comorbid Conditions

    Directory of Open Access Journals (Sweden)

    Karimi-Sari

    2015-04-01

    Full Text Available Background Nonalcoholic fatty liver disease (NAFLD is one of the most common causes of chronic liver disease including simple steatosis to nonalcoholic steatohepatitis (NASH. NASH could progress to cirrhosis and liver cancer. The prevalence of NAFLD is increasing by increasing the prevalence of obesity. Objectives This study was designed to determine the prevalence of NASH in morbidly obese patients undergoing sleeve bariatric surgery and its correlation with other comorbidities. Patients and Methods In this analytical cross-sectional study, 114 morbidly obese patients undergoing sleeve gastrectomy were selected. Liver ultrasonography was performed for all patients before surgery and NAFLD existence and its grade was determined by hyperechoic texture and fatty infiltration. The liver enzymes and lipid profile were also measured. Prevalence of NAFLD in these patients and its correlation with other comorbid conditions (e.g. diabetes mellitus, hyperlipidemia, hypertension, hypothyroidism and ischemic heart disease were evaluated by SPSS software version 18. Results One hundred fourteen patients with a mean age of 33.96 ± 9.92 years and mean BMI of 43.61 ± 5.77 kg/m2 were enrolled (48 males and 66 females. The prevalence of NAFLD was 16.7%. NAFLD existence was associated with systolic blood pressure, hyperlipidemia, hemoglobin, hematocrit, triglyceride, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and potassium (P < 0.05. Conclusions According to high prevalence of NAFLD in morbidly obese patients undergoing sleeve gastrectomy in Iran, we suggest using gold standard diagnostic method to determine the exact NAFLD prevalence and evaluation of impact of sleeve surgery on NAFLD in short and long term follow-up periods.

  19. The TaSST: Tactile Sleeve for Social Touch

    NARCIS (Netherlands)

    Huisman, G.; Darriba Frederiks, A.; van Dijk, B.; Heylen, D.; Kröse, B.

    2013-01-01

    In this paper we outline the design process of the TaSST (Tactile Sleeve for Social Touch), a touch-sensitive vibrotactile arm sleeve. The TaSST was designed to enable two people to communicate different types of touch over a distance. The touch-sensitive surface of the sleeve consists of a grid of

  20. The TaSST: Tactile sleeve for social touch

    NARCIS (Netherlands)

    Huisman, Gijs; Darriba Frederiks, Aduén; van Dijk, Elisabeth M.A.G.; Heylen, Dirk K.J.; Krose, Ben

    In this paper we outline the design process of the TaSST (Tactile Sleeve for Social Touch), a touch-sensitive vibrotactile arm sleeve. The TaSST was designed to enable two people to communicate different types of touch over a distance. The touch-sensitive surface of the sleeve consists of a grid of

  1. The TaSST - Tactile Sleeve for Social Touch

    NARCIS (Netherlands)

    Huisman, Gijs; Darriba Frederiks, Aduén; Van Dijk, Betsy; Heylen, Dirk

    2013-01-01

    In this paper we outline the design process of TaSST (Tactile Sleeve for Social Touch), a touch-sensitive vibrotactile arm sleeve. The TaSST was designed to enable two people to communicate different types of touches over a distance. The touch-sensitive surface of the sleeve consists of a grid of

  2. [Valuation and prospect of function preserving gastrectomy].

    Science.gov (United States)

    Wang, Shuchang; Yu, Site; Xu, Jia; Zhao, Gang

    2017-10-25

    Preserving gastric function and improving quality of life (QOL) is the tendency of surgery for early gastric cancer. Function preserving gastrectomy (FPG) is applied to modify the extent of surgery and to achieve better quality of life at the premise of radical resection. Pylorus-preserving gastrectomy is the most favorable approach of FPG with oncological safety, which can improve nutritional status and QOL via preserving pylorus and vagal nerve. Proximal gastrectomy is widely accepted as FPG for early upper 1/3 gastric cancer. However, the most optimal way of anastomosis is not yet solved. Sentinel node navigation is currently the most accurate approach for intraoperative diagnosis of lymph node metastasis, which stimulates the development of many kinds of FPG procedures for individual treatment. Nevertheless, more efforts should be made to reduce false negative rate of sentinel node biopsy. Herein we discuss the valuation and prospect of FPG.

  3. Revisional bariatric surgery after failed laparoscopic adjustable gastric banding - a single-center, long-term retrospective study.

    Science.gov (United States)

    Kowalewski, Piotr K; Olszewski, Robert; Kwiatkowski, Andrzej P; Paśnik, Krzysztof

    2017-01-01

    Laparoscopic adjustable gastric banding (LAGB) used to be one of the most popular bariatric procedures. To present our institution's experience with LAGB, its complications, causes of failure and revisional bariatric procedures, in a long-term follow-up. Records of patients who underwent pars flaccida LAGB from 2003 to 2006 were gathered. We selected data on patients with a history of additional bariatric procedures. Their initial demographic data, body mass index and causes of revision were gathered. We analyzed length of stay and early perioperative complications. 60% of patients (n = 57) who underwent LAGB in our institution between 2003 and 2006 had their band removed (out of 107, 11% lost to follow-up). Median time to revisional surgery was 50 months. The main reasons for removal were: weight regain (n = 23; 40%), band slippage (n = 14; 25%), and pouch dilatation (n = 9; 16%). Thirty (53%) patients required additional bariatric surgery, 10 (33%) of which were simultaneous with band removal. The most popular procedures were: laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 15; 50%), open gastric bypass (n = 8; 27%), and laparoscopic sleeve gastrectomy (LSG) - (n = 3; 10%). Mean length of stay (LOS) was 5.4 ±2.0. One (3%) perioperative complication was reported. The results show that LAGB is not an effective bariatric procedure in long-term follow-up due to the high rate of complications causing band removal and the high rate of obesity recurrence. Revisional bariatric surgery after failed LAGB may be performed in a one-stage approach with band removal.

  4. Performance of Grouted Splice Sleeve Connector under Tensile Load

    Directory of Open Access Journals (Sweden)

    A. Alias

    2016-05-01

    Full Text Available The grouted splice sleeve connector system takes advantage of the bond-slip resistance of the grout and the mechanical gripping of reinforcement bars to provide resistance to tensile force. In this system, grout acts as a load-transferring medium and bonding material between the bars and sleeve. This study adopted the end-to-end rebars connection method to investigate the effect of development length and sleeve diameter on the bonding performance of the sleeve connector. The end-to-end method refers to the condition where reinforcement bars are inserted into the sleeve from both ends and meet at the centre before grout is filled. Eight specimens of grouted splice sleeve connector were tested under tensile load to determine their performance. The sleeve connector was designed using 5 mm thick circular hollow section (CHS steel pipe and consisted of one external and two internal sleeves. The tensile test results show that connectors with a smaller external and internal sleeve diameter appear to provide better bonding performance. Three types of failure were observed in this research, which are bar fracture (outside the sleeve, bar pullout, and internal sleeve pullout. With reference to these failure types, the development length of 200 mm is the optimum value due to its bar fracture type, which indicates that the tensile capacity of the connector is higher than the reinforcement bar. It is found that the performance of the grouted splice sleeve connector is influenced by the development length of the reinforcement bar and the diameter of the sleeve.

  5. [Laparoscopic gastric sleeve in gastric volvulus secondary to diaphragmatic eventration in an adult patient].

    Science.gov (United States)

    Gálvez-Valdovinos, Ramiro; Marín-Santillán, Ernesto; Funes-Rodríguez, Juan Francisco; López-Ambriz, Gustavo

    2016-01-01

    Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastrointestinal obstruction. Male of 60 years old with severe epigastric pain and abdominal distension with haematemesis on two occasions. The patient was haemodynamically stable, with abdominal distension and palpable epigastric fullness. Hematic cytology showed: haemoglobin 8.2g/dl and haematocrit 27%. Abdominal X-ray showed an elevation of left diaphragm with a hugely dilated stomach. A nasogastric tube was inserted. Endoscopy was performed. There was no active bleeding, but it was impossible to reach the duodenum due to the stomach distortion. The upper gastrointestinal X-ray study showed the appearance of an inverted stomach in the chest and an organoaxial gastric torsion. The CT scans of thorax and abdomen showed a gastric ascent into the thoracic cavity. Laparoscopic surgery was performed, finding the left hemi-diaphragm elevated, and the stomach, splenic angle of the colon, the spleen and tail of the pancreas were also raised. A linear gastrectomy (gastric sleeve) was performed. The postoperative progress was satisfactory. Oral feeding was started 72 hours after surgery, and the patient was discharged, and has remained asymptomatic during the following by 8 years. Emergency physicians must maintain a high level of suspicion in patients that present with signs and symptoms suggesting upper digestive tract occlusion. The gastric sleeve is an excellent alternative to avoid recurrence of gastric volvulus. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  6. Reconstruction of the esophagojejunostomy by double stapling method using EEA™ OrVil™ in laparoscopic total gastrectomy and proximal gastrectomy

    OpenAIRE

    Hirahara, Noriyuki; Monma, Hiroyuki; Shimojo, Yoshihide; Matsubara, Takeshi; Hyakudomi, Ryoji; Yano, Seiji; Tanaka, Tsuneo

    2011-01-01

    Abstract Here we report the method of anastomosis based on double stapling technique (hereinafter, DST) using a trans-oral anvil delivery system (EEATM OrVilTM) for reconstructing the esophagus and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection. As a basic technique, laparoscopic total gastrectomy employed Roux-en-Y reconstruction, laparoscopic proximal gastrectomy employed double tract reconstruction, and end-to-side anastomosis was used for the cut-off...

  7. Laparoscopic vs open gastrectomy. A retrospective review.

    Science.gov (United States)

    Reyes, C D; Weber, K J; Gagner, M; Divino, C M

    2001-09-01

    The totally laparoscopic approach to partial gastrectomy had not been compared previously with results of the open technique. This study compares the results of a series of laparoscopic cases with matched open cases. A retrospective case-matched study was performed in 36 patients (18 laparoscopic surgeries, 18 open surgeries). Each laparoscopic case was matched for patient age and indication for surgery. The intraoperative and postoperative details of the two groups were compared. Laparoscopic surgery resulted in less blood loss, although operative time was increased. Nasogastric tubes were less likely to be used after laparoscopic surgery, and patients in the laparoscopic group had an earlier return to normal bowel function than those in the open group. Length of hospital stay was 2 days shorter in the laparoscopic group. The totally laparoscopic approach to partial gastrectomy is an excellent alternative to the more traditional open approach. It results in a more rapid return of intestinal function and a shorter hospital stay.

  8. Prophylactic nasogastric decompression for routine gastrectomy

    International Nuclear Information System (INIS)

    Pang, M.H.; Luo, B.

    2015-01-01

    Objective: To determine the necessity of using nasogastric tubes for patients with gastrectomy. Study Design: Anon-randomized controlled trial with two arms. Place and Duration of Study: Sichuan Provincial Peoples' Hospital, China, from February 2012 to January 2014. Methodology: One hundred and twenty one patients undergoing gastrectomy were assigned into intubation group and control group based on patient's own will. The intubation group was intubated with a nasogastric tube before operation and extubated at the earliest evidence of passed flatus. Clinical outcomes, such as operation time, bleeding volume, time to passage of flatus, postoperative complications, and length of stay were recorded and compared between the two groups along with patient characteristics. Results: The two groups did not differ in patient characteristics with similar distribution of gender, age, diagnosis, tumor location and operation type. Nasogastric intubation before surgery was not associated with statistically significant difference in total surgery duration, bleeding volume of operation or postoperative complications. In addition, patients without nasogastric tubes resumed oral diet earlier (52.5 ± 14.1 vs.18.4 ± 2.0 hours, p < 0.05) and had shorter time to first passage of flatus (43.8 ± 11.2 vs. 49.0 ± 13.3 hours, p=0.02). Conclusion: It is safe to give up nasogastric intubation for patients undergoing elective gastrectomy and may even result in a better patient outcome. (author)

  9. Emergency total gastrectomy for massive haemorrhage in a low ...

    African Journals Online (AJOL)

    Background: Gastric cancer is the second most common cancer of the gastrointestinal tract behind colorectal cancer in Cameroon. Total gastrectomy which is recommended for proximal gastric cancer is rarely performed and has not been reported in this country. Aim: To report emergency gastrectomy for life threatening ...

  10. [Nutritional status in patients after gastrectomy due to gastric cancer].

    Science.gov (United States)

    Khomichuk, A L; Shakhovskaia, A K; Isakov, V A; Sharafetdinov, Kh Kh; Blokhina, L V

    2012-01-01

    Aim of the study was to evaluate nutritional status in patients after gastrectomy due to gastric cancer. In 55 (26 males and 29 females) gastric cancer patients after gastrectomy body composition (bioimpedansometry method); resting energy expenditures and home actual nutrition (frequency analysis method) were evaluated. Blood levels of major nutrients and metabolites were assessed. Both men and women suffered from weight loss after gastrectomy (mean BMI was 19,8+/-4,7 kg/m2 in men and 20,5+/-1,9 in women). Higher BMI was positively correlated with age in women (R=0,45; pgastric cancer patients low BMI, low fat mass and energy consumption are observed even long period of time after gastrectomy. Dietary counseling and support are badly needed in patients short-term as well as long-term period after gastrectomy in men and younger women.

  11. Microfabricated sleeve devices for chemical reactions

    Science.gov (United States)

    Northrup, M. Allen

    2003-01-01

    A silicon-based sleeve type chemical reaction chamber that combines heaters, such as doped polysilicon for heating, and bulk silicon for convection cooling. The reaction chamber combines a critical ratio of silicon and non-silicon based materials to provide the thermal properties desired. For example, the chamber may combine a critical ratio of silicon and silicon nitride to the volume of material to be heated (e.g., a liquid) in order to provide uniform heating, yet low power requirements. The reaction chamber will also allow the introduction of a secondary tube (e.g., plastic) into the reaction sleeve that contains the reaction mixture thereby alleviating any potential materials incompatibility issues. The reaction chamber may be utilized in any chemical reaction system for synthesis or processing of organic, inorganic, or biochemical reactions, such as the polymerase chain reaction (PCR) and/or other DNA reactions, such as the ligase chain reaction, which are examples of a synthetic, thermal-cycling-based reaction. The reaction chamber may also be used in synthesis instruments, particularly those for DNA amplification and synthesis.

  12. A Wideband Dual-Polarized Antenna Using Planar Quasi-Open-Sleeve Dipoles for Base Station Applications

    Directory of Open Access Journals (Sweden)

    Guan-xi Zhang

    2015-01-01

    Full Text Available A wideband dual-polarized antenna for WLAN, WiMAX, and LTE base station applications is presented in this paper. The proposed antenna consists of two pairs of orthogonal planar quasi-open-sleeve dipoles along the centerlines, a balanced feeding structure and a square ground plane. The planar quasi-open-sleeve dipole comprises a pair of bowtie-shaped planar dipoles with two parallel curve parasitic elements. The introduced parallel curve parasitic elements change the path of the current of the original bowtie-shaped planar dipoles at high frequencies and hence wideband characteristic is achieved. Two pairs of the planar quasi-open-sleeve dipoles placed orthogonally further broaden the bandwidth of the antenna with dual-polarization characteristics. The proposed antenna achieves a 10-dB return loss bandwidth from 2.32 to 4.03 GHz (53.9% bandwidth using the planar quasi-open-sleeve dipole structures. The isolation between the two ports remains more than 32 dB in the whole bandwidth. Measured results show that the proposed antenna keeps the cross-polarization under −33 dB and the front-to-back ratio better than 15 dB in the operating band. The antenna has an area of 0.3λ  × 0.3λ at 2.32 GHz making it easy to be extended to an array element.

  13. Food intake and nutritional status after gastrectomy

    DEFF Research Database (Denmark)

    Bisballe, S; Buus, S; Lund, B

    1986-01-01

    Food intake and nutritional status was studied in 67 patients, who had had a gastrectomy 2-30 years earlier, and in a randomly selected, matched group of healthy persons. The gastrectomized patients weighed less than the control persons (women 56.4 +/- 9.5 vs 61.4 +/- 6.9 kg; P less than 0.05; men.......01). The serum concentration of alkaline phosphatase was raised and the concentration of calcium, phosphorus and 25-hydroxycholecalciferol reduced in the gastrectomized group. None of these results could be explained from the nutritional study as both the intake of energy and protein and the intake of calcium...

  14. Sleeve type repair of degraded nuclear steam generator tubes

    International Nuclear Information System (INIS)

    Ayres, P.S.; Stark, L.E.; Feldstein, J.G.; Fu, T.

    1986-01-01

    A sealable sleeve is described for insertion into the repair of a degraded tube which consists of: a hollow core inner member of the same material as the degraded tube; a thinner outer member of substantially pure nickel and resistant to corrosive attack, the outer member being metallurgically bonded with the inner member; an expanded portion of the sleeve at one end for positioning in the tube within a tube sheet; a multiplicity of grooves formed in and adjacent to the other end of the sleeve which extends into the free-standing portion of the tube beyond the tube sheet, and a noble metal braze material contained in the grooves

  15. Total gastrectomy due to ferric chloride intoxication.

    Science.gov (United States)

    Menéndez, A Mesut; Abramson, Leonardo; Vera, Raúl A; Duza, Guillermo E; Palermo, Mariano

    2015-09-01

    The ferric chloride intoxication is frequently caused by accident. Its toxicity is generally underrated, which can lead to fatal evolution or irreversible consequences. In this case, the caustic condition of the substance is related to the toxic properties of iron. A 36-year-old male patient arrives by ambulance indicating sensory deterioration. He presents erosive injuries in the buccal cavity and in the oropharynx, brownish teeth and metabolic acidosis. Toxicology tests and ferritin blood dosage are requested, which show a result from 1400 mg/dl. The symptoms are interpreted as acute iron intoxication. Due to the unfavorable evolution of his condition, an abdominal and pelvic CT scan are performed, which show extensive pneumoperitoneum and free fluid in the abdominal cavity. An exploratory laparotomy, a total gastrectomy with esophagostomy and feeding jejunostomy, washing and drainage due to perforated gastric necrosis caused by caustic ingestion are performed. In our country, there is a high rate of intoxication caused by iron compounds, although it is not statistically measured. Nevertheless, the ferric chloride intoxication is extremely infrequent. The ingestion of this product leads to complications, which are associated with the iron concentration and its condition as a caustic agent. The surgical indications in the presence of intoxication caused by iron compounds are: stomach evacuation of iron, gastric necrosis, perforation or peritonitis and stenosis. Early or prophylactic gastrectomy is contraindicated. However, if complications that require immediate surgical intervention arise, there should be no hesitation and the corresponding procedure should be performed.

  16. Seismic retrofit of spliced sleeve connections for precast bridge piers.

    Science.gov (United States)

    2017-03-01

    Grouted Splice Sleeve (GSS) connectors are being considered for connecting bridge columns, footings, and pier caps in Accelerated Bridge Construction (ABC). A repair technique for precast reinforced concrete bridge column-to-footing and column-to-pie...

  17. Gastrectomy with limited surgery for elderly patients with gastric cancer

    Directory of Open Access Journals (Sweden)

    Koji Mikami

    2018-01-01

    Conclusion: Gastrectomy according to the gastric treatment guidelines for elderly patients with gastric cancer is recommended. Elderly male patients with poor nutrition have poor prognosis; prognostic nutrition index <40. Limited surgery is a treatment option for such patients.

  18. Dual-port distal gastrectomy for the early gastric cancer

    OpenAIRE

    Kashiwagi, Hiroyuki; Kumagai, Kenta; Monma, Eiji; Nozue, Mutsumi

    2014-01-01

    Background Although recent trends in laparoscopic procedures have been toward minimizing the number of incisions, four or five ports are normally required to complete laparoscopic gastrectomy because of the complexity of this procedure. Multi-channel ports, such as the SILS port (Covidien, JAPAN), are now available and are crucial for performing single-incision laparoscopic surgery (SILS) or reduced port surgery (RPS). We carried out reduced port distal gastrectomy (RPDG) using a dual-port me...

  19. Evaluation of Safety and Efficacy of the EndoLift Liver Retractor

    Science.gov (United States)

    2015-08-03

    Minimally Invasive Surgical Procedure; Laparoscopic Gastric Banding; Laparoscopic Roux-en-Y Gastric Bypass; Laparoscopic Sleeve Gastrectomy; Laparoscopic Fundoplication Procedure; Laparoscopic Heller Myotomy; Laparoscopic Paraesophageal Hernia Repair; Laparoscopic Gastric Resection

  20. All carbon coaxial supercapacitors based on hollow carbon nanotube sleeve structure

    International Nuclear Information System (INIS)

    Zang, Xiaobei; Xu, Ruiqiao; Zhang, Yangyang; Zhang, Li; Wei, Jinquan; Wang, Kunlin; Zhu, Hongwei; Li, Xinming

    2015-01-01

    All carbon coaxial supercapacitors based on hollow carbon nanotube (CNT) sleeve structure are assembled and tested. The key advantage of the structure is that the inner core electrode is variable from CNT sleeve sponges, to CNT fibers, reduced graphene oxide fibers, and graphene woven fabrics. By changing core electrodes from sleeve sponges to CNT fibers, the electrochemical performance has been significantly enhanced. The capacitance based on sleeve sponge + CNT fiber double the capacitances of double-sleeve sponge supercapacitors thanks to reduction of the series and internal resistances. Besides, the coaxial sleeve structure possesses many other features, including high rate capacitance, long cycle life, and good flexibility. (paper)

  1. Endoscopic sleeve gastroplasty: the learning curve.

    Science.gov (United States)

    Hill, Christine; El Zein, Mohamad; Agnihotri, Abhishek; Dunlap, Margo; Chang, Angela; Agrawal, Alison; Barola, Sindhu; Ngamruengphong, Saowanee; Chen, Yen-I; Kalloo, Anthony N; Khashab, Mouen A; Kumbhari, Vivek

    2017-09-01

     Endoscopic sleeve gastroplasty (ESG) is gaining traction as a minimally invasive bariatric treatment. Concern that the learning curve may be slow, even among those proficient in endoscopic suturing, is a barrier to widespread implementation of the procedure. Therefore, we aimed to define the learning curve for ESG in a single endoscopist experienced in endoscopic suturing who participated in a 1-day ESG training program.  Consecutive patients who underwent ESG between February 2016 and November 2016 were included. The performing endoscopist, who is proficient in endoscopic suturing for non-ESG procedures, participated in a 1-day ESG training session before offering ESG to patients. The outcome measurements were length of procedure (LOP) and number of plications per procedure. Nonlinear regression was used to determine the learning plateau and calculate the learning rate.  Twenty-one consecutive patients (8 males), with mean age 47.7 ± 11.2 years and mean body mass index 41.8 ± 8.5 kg/m 2 underwent ESG. LOP decreased significantly across consecutive procedures, with a learning plateau at 101.5 minutes and a learning rate of 7 cases ( P  = 0.04). The number of plications per procedure also decreased significantly across consecutive procedures, with a plateau at 8 sutures and a learning rate of 9 cases ( P  < 0.001). Further, the average time per plication decreased significantly with consecutive procedures, reaching a plateau at 9 procedures ( P  < 0.001).  Endoscopists experienced in endoscopic suturing are expected to achieve a reduction in LOP and number of plications per procedure in successive cases, with progress plateauing at 7 and 9 cases, respectively.

  2. Sleeve Push Technique: A Novel Method of Space Gaining.

    Science.gov (United States)

    Verma, Sanjeev; Bhupali, Nameksh Raj; Gupta, Deepak Kumar; Singh, Sombir; Singh, Satinder Pal

    2018-01-01

    Space gaining is frequently required in orthodontics. Multiple loops were initially used for space gaining and alignment. The most common used mechanics for space gaining is the use of nickel-titanium open coil springs. The disadvantage of nickel-titanium coil spring is that they cannot be used until the arches are well aligned to receive the stiffer stainless steel wires. Therefore, a new method of gaining space during initial alignment and leveling has been developed and named as sleeve push technique (SPT). The nickel-titanium wires, i.e. 0.012 inches and 0.014 inches along with archwire sleeve (protective tubing) can be used in a modified way to gain space along with alignment. This method helps in gaining space right from day 1 of treatment. The archwire sleeve and nickel-titanium wire in this new SPT act as a mutually synergistic combination and provide the orthodontist with a completely new technique for space opening.

  3. Self Touch to Touch Others: Designing the Tactile Sleeve for Social Touch

    NARCIS (Netherlands)

    Huisman, G.; Darriba Frederiks, A.; van Dijk, B.; Kröse, B.; Heylen, D.

    2013-01-01

    In this paper we present the concept and initial design stages of the TaSST (Tactile Sleeve for Social Touch). The TaSST consists of a soft pressure-sensitive input layer, and an output layer containing vibration motors. A touch to ones own sleeve is felt as a vibration on the sleeve of another

  4. Self touch to touch others : designing the tactile sleeve for social touch

    NARCIS (Netherlands)

    Huisman, Gijs; Darriba Frederiks, Aduén; Heylen, Dirk; Van Dijk, Betsy; Kröse, Ben

    2013-01-01

    In this paper we present the concept and initial design stages of the TaSST (Tactile Sleeve for Social Touch). The TaSST consists of a soft pressure-sensitive input layer, and an output layer containing vibration motors. A touch to ones own sleeve is felt as a vibration on the sleeve of another

  5. Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions.

    Science.gov (United States)

    Huh, Jeannie; Easley, Mark E; Nunley, James A

    2016-06-01

    An Achilles sleeve avulsion occurs when the tendon ruptures distally from its calcaneal insertion as a continuous "sleeve." This relatively rare injury pattern may not be appreciated until the time of surgery and can be challenging to treat because, unlike a midsubstance rupture, insufficient tendon remains on the calcaneus to allow for end-to-end repair, and unlike a tuberosity avulsion fracture, any bony element avulsed with the tendon is inadequate for internal fixation. This study aimed to highlight the characteristics of Achilles sleeve avulsions and present the outcomes of operative repair using suture anchor fixation. A retrospective analysis was conducted on 11 consecutive Achilles tendon sleeve avulsions (10 males, 1 female; mean age 44 years) that underwent operative repair between 2008 and 2014. Patient demographics, injury presentation, and operative details were reviewed. Postoperative outcomes were collected at a mean follow-up of 38.4 (range, 12-83.5) months, including the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, visual analog scale (VAS) for pain, plantarflexion strength, patient satisfaction, and complications. Eight patients (72.7%) had preexisting symptoms of insertional Achilles disease. Ten of 11 (90.9%) injuries were sustained during recreational athletic activity. An Achilles sleeve avulsion was recognized preoperatively in 7 of 11 (64%) cases, where lateral ankle radiographs demonstrated a small radiodensity several centimeters proximal to the calcaneal insertion. Intraoperatively, 90.9% of sleeve avulsions had a concomitant Haglund deformity and macroscopic evidence of insertional tendinopathy. All patients healed after suture anchor repair. The average AOFAS score was 92.8 and VAS score was 0.9. Ten patients (90.9%) were completely satisfied. One complication occurred, consisting of delayed wound healing. Achilles tendon sleeve avulsions predominantly occurred in middle-aged men with preexisting insertional

  6. Sleeve Muscle Actuator and Its Application in Transtibial Prostheses

    Science.gov (United States)

    Zheng, Hao; Shen, Xiangrong

    2014-01-01

    This paper describes the concept of a new sleeve muscle actuator, and a transtibial prosthesis design powered by this novel actuator. Inspired by the functioning mechanism of the traditional pneumatic muscle actuator, the sleeve muscle actuator incorporates a cylindrical insert to the center of the pneumatic muscle, which eliminates the central portion of the internal volume. As a result of this change, the sleeve muscle provides multiple advantages over the traditional pneumatic muscle, including the increased force capacity over the entire range of motion, reduced energy consumption, and faster dynamic response. Furthermore, utilizing the load-bearing tube as the insert, the sleeve muscle enables an innovative “actuation-load bearing” structure, which has a potential of generating a highly compact actuation system suitable for prosthetic use. Utilizing this new actuator, the preliminary design of a transtibial prosthesis is presented, which is able to provide sufficient torque output and range of motion for a 75 Kg amputee user in level walking. PMID:24187262

  7. Patellar Sleeve Fracture With Ossification of the Patellar Tendon.

    Science.gov (United States)

    Damrow, Derek S; Van Valin, Scott E

    2017-03-01

    Patellar sleeve fractures make up greater than 50% of all patellar fractures. They are essentially only seen in the pediatric population because of the thick periosteum and the distal patellar pole apophysis in this group. These fractures can lead to complications if not treated appropriately and in a timely fashion. Complications of missed or untreated patellar sleeve fractures include patella alta, anterior knee pain, and quadriceps atrophy. These can all result in severe limitations in activity. The authors describe a case of a 16-year-old boy who sustained a patellar sleeve fracture 3 years prior to presentation. On presentation, he had patella alta, diminished strength, 5° of extensor lag, and radiographs that revealed bone formation along the patellar tendon. Despite this, he was able to maintain a high level of activity. This case report explores how the patient could have maintained a high level of activity despite having a patellar sleeve fracture. Also, because of the delayed presentation, the patella was ossified and the quadriceps was retracted, which led to a novel approach to reconstructing his distal extensor mechanism. This approach included a V-Y advancement of the quadriceps tendon and patellar tendon reconstruction using the patient's hamstring tendon (semitendinosus). This technique, combined with physical therapy postoperatively, resulted in his return to varsity high school soccer. To the best of the authors' knowledge, this technique has not been reported for this rare condition. [Orthopedics. 2017; 40(2):e357-e359.]. Copyright 2016, SLACK Incorporated.

  8. Retained copper sleeve of cu-T IUCD

    African Journals Online (AJOL)

    Dr Adaji

    Case Report. A 47-year old para 7+1 five alive presented at the. Reproductive Health center for removal of a copper-T intrauterine contraceptive device following a clinical diagnosis of pelvic inflammatory disease. The device was inserted the previous year. After easy removal , it was observed that the copper sleeve on one ...

  9. Mesentero-axial gastric volvulus after removal of laparoscopic adjustable gastric band.

    Science.gov (United States)

    Pirmadjid, N; Pournaras, D J; Huan, S; Sujendran, V

    2017-02-01

    Despite the decreasing popularity of gastric banding, a large number of patients still have a band in situ. Although immediate postoperative complications are relatively rare, long-term complications of gastric banding are more common but are not reported to occur after band removal. We report a case of gastric volvulus and subsequent ischaemic perforation in a patient shortly after band removal, resulting in emergency laparotomy and total gastrectomy. Severe continuing pain persisting after band deflation and even gastric band removal should be treated as an emergency and urgent investigation should not be delayed.

  10. Retrograde jejunal intussusception after total gastrectomy: A case ...

    African Journals Online (AJOL)

    Retrograde jejunal intussusception is a rare disease. A 60‑year‑old female patient was hospitalized due to vomiting for 2 days, with a history of radical gastrectomy plus esophagus jejunum Rouxs‑en‑Y. On examination, there was a palpable wax‑like mass on the left‑hand side underneath the umbilicus. Computerized ...

  11. Retrograde jejunal intussusception after total gastrectomy: A case ...

    African Journals Online (AJOL)

    2015-11-02

    Nov 2, 2015 ... Retrograde jejunal intussusception is a rare disease. A 60-year-old female patient was hospitalized due to vomiting for 2 days, with a history of radical gastrectomy plus esophagus jejunum Rouxs-en-Y. On examination, there was a palpable wax-like mass on the left-hand side underneath the umbilicus.

  12. Postoperative Outcomes of Minimally Invasive Gastrectomy Versus Open Gastrectomy During the Early Introduction of Minimally Invasive Gastrectomy in the Netherlands: A Population-based Cohort Study.

    Science.gov (United States)

    Brenkman, Hylke J F; Gisbertz, Suzanne S; Slaman, Annelijn E; Goense, Lucas; Ruurda, Jelle P; van Berge Henegouwen, Mark I; van Hillegersberg, Richard

    2017-11-01

    To compare postoperative outcomes of minimally invasive gastrectomy (MIG) to open gastrectomy (OG) for cancer during the introduction of MIG in the Netherlands. Between 2011 and 2015, the use of MIG increased from 4% to 53% in the Netherlands. This population-based cohort study included all patients with curable gastric adenocarcinoma that underwent gastrectomy between 2011 and 2015, registered in the Dutch Upper GI Cancer Audit. Patients with missing preoperative data, and patients in whom no lymphadenectomy or reconstruction was performed were excluded. Propensity score matching was applied to create comparable groups between patients receiving MIG or OG, using year of surgery and other potential confounders. Morbidity, mortality, and hospital stay were evaluated. Of the 1697 eligible patients, 813 were discarded after propensity score matching; 442 and 442 patients who underwent MIG and OG, respectively, remained. Conversions occurred in 10% of the patients during MIG. Although the overall postoperative morbidity (37% vs 40%, P = 0.489) and mortality rates (6% vs 4%, P = 0.214) were comparable between the 2 groups, patients who underwent MIG experienced less wound complications (2% vs 5%, P = 0.006). Anastomotic leakage occurred in 8% of the patients after MIG, and in 7% after OG (P = 0.525). The median hospital stay declined over the years for both procedures (11 to 8 days, P Netherlands, with overall morbidity and mortality comparable with OG, less wound complications and shorter hospitalization.

  13. ENDOSCOPIC SLEEVE GASTROPLASTY FOR OBESITY TREATMENT: TWO YEARS OF EXPERIENCE.

    Science.gov (United States)

    Lopez-Nava, Gontrand; Galvão, M P; Bautista-Castaño, I; Fernandez-Corbelle, J P; Trell, M; Lopez, N

    2017-01-01

    Bariatric endoscopic techniques are minimally invasive and induce gastric volume reduction to treat obesity. Aim : To evaluate endoscopic sleeve gastroplasty (Apollo method) using a suturing method directed at the greater curvature, as well as the perioperative care, two year safety and weight loss. Prospective single-center study over 154 patients (108 females) using the endoscopic sleeve gastroplasty procedure under general anesthesia with overnight inpatient observation. Of the154 initial patients, 143 were available for 1-month of follow-up, 133 for 6-month, 64 for 12-month and 28 completed the 24 month assessment. Follow-up was carried out by a multidisciplinary team (nutritionist and psychologist). Outcomes evaluated were: change in BMI; change in body weight (TBWL); % of loss of initial body weight (%TBWL); % of excess body weight loss (%EWL) (segregated in > or 25% %EWL. There were no mayor adverse events intraprocedure or during the 24 months of follow-up . Endoscopic sleeve gastroplasty with regular monitoring by a multidisciplinary team can be considered an effective, safe and well tolerated procedure for obesity treatment, at least for two years of follow-up. As técnicas de endoscopia bariátrica são minimamente invasivas e induzem à redução do volume gástrico para tratar a obesidade. Avaliar a gastroplastia sleeve endoscópica (método Apollo) usando um método de sutura direcionado para a grande curvatura, bem como os cuidados perioperatórios, segurança em dois anos e perda de peso. Estudo prospectivo em um único centro com 154 pacientes (108 mulheres) usando o procedimento endoscópico de gastroplastia sleeve sob anestesia geral com observação do paciente internado durante a noite. Dos 154 pacientes iniciais, 143 estiveram disponíveis para acompanhamento de um mês, 133 durante seis meses, 64 durante 12 meses e 28 completaram a avaliação de 24 meses. O acompanhamento foi realizado por equipe multidisciplinar (nutricionista e psic

  14. Silicon-based sleeve devices for chemical reactions

    Science.gov (United States)

    Northrup, M. Allen; Mariella, Jr., Raymond P.; Carrano, Anthony V.; Balch, Joseph W.

    1996-01-01

    A silicon-based sleeve type chemical reaction chamber that combines heaters, such as doped polysilicon for heating, and bulk silicon for convection cooling. The reaction chamber combines a critical ratio of silicon and silicon nitride to the volume of material to be heated (e.g., a liquid) in order to provide uniform heating, yet low power requirements. The reaction chamber will also allow the introduction of a secondary tube (e.g., plastic) into the reaction sleeve that contains the reaction mixture thereby alleviating any potential materials incompatibility issues. The reaction chamber may be utilized in any chemical reaction system for synthesis or processing of organic, inorganic, or biochemical reactions, such as the polymerase chain reaction (PCR) and/or other DNA reactions, such as the ligase chain reaction, which are examples of a synthetic, thermal-cycling-based reaction. The reaction chamber may also be used in synthesis instruments, particularly those for DNA amplification and synthesis.

  15. Computed tomography of cystic nerve root sleeve dilatation.

    Science.gov (United States)

    Neave, V C; Wycoff, R R

    1983-10-01

    A case of cystic nerve root sleeve dilatation in the lumbar area associated with a chronic back pain syndrome is presented. Prominent computed tomography (CT) findings include: (a) rounded masses in the region of the foramina isodense with cerebrospinal fluid in the subarachnoid space; (b) associated asymmetry of epidural fat distribution; (c) enlargement of the neural foramina in axial sections with scalloped erosion of the adjacent posteriolateral vertebral body, pedicle, and pedicular-laminar junction with preservation of cortex and without bony sclerosis or infiltrative appearance; (d) prominent or ectatic dural sac with lack of usual epidural landmarks between the sac and vertebral body; and (e) multilevel abnormalities throughout the entire lumbar region. Myelographic and CT correlations are demonstrated with a review of the literature. A discussion of the various cystic abnormalities involving nerve root sheaths is undertaken in an attempt to clarify the confusing nomenclature applied to nerve root sleeve pathology.

  16. Sleeve resection for delayed presentation of traumatic bronchial transection.

    LENUS (Irish Health Repository)

    Mohamed, H Y

    2010-02-01

    Tracheobronchial disruption is uncommon in blunt chest trauma. Many of these patients die before reaching the hospital. In the majority of survivors diagnosis is occasionally delayed resulting in complications like airway stenosis and lung collapse. Thus it is important to have radiological follow up after severe thoracic trauma. Sleeve resection can be an excellent option to conserve lung tissue in delayed presentation of bronchial transection.

  17. The effective neutron temperature in heated graphite sleeves

    Energy Technology Data Exchange (ETDEWEB)

    Shaw, J A; Small, V G [General Reactor Physics Division, Atomic Energy Establishment, Winfrith, Dorchester, Dorset (United Kingdom)

    1963-08-15

    In a series of oscillator measurements carried out in the reactor NERO the variation of the relative reaction rates of cadmium and boron absorbers has been used to determine the effective neutron temperature inside heated graphite sleeves. This work extends the scope of similar oscillator measurements previously carried out in DIMPLE, in that the bulk moderator is now graphite as opposed to D{sub 2}O in the former case. (author)

  18. Surgical Outcomes After Open, Laparoscopic, and Robotic Gastrectomy for Gastric Cancer.

    Science.gov (United States)

    Yang, Seung Yoon; Roh, Kun Ho; Kim, You-Na; Cho, Minah; Lim, Seung Hyun; Son, Taeil; Hyung, Woo Jin; Kim, Hyoung-Il

    2017-07-01

    In contrast to the significant advantages of laparoscopic versus open gastrectomy, robotic gastrectomy has shown little benefit over laparoscopic gastrectomy. This study aimed to compare multi-dimensional aspects of surgical outcomes after open, laparoscopic, and robotic gastrectomy. Data from 915 gastric cancer patients who underwent gastrectomy by one surgeon between March 2009 and May 2015 were retrospectively reviewed. Perioperative parameters were analyzed for short-term outcomes. Surgical success was defined as the absence of conversion to open surgery, major complications, readmission, positive resection margin, or fewer than 16 retrieved lymph nodes. This study investigated 241 patients undergoing open gastrectomy, 511 patients undergoing laparoscopic gastrectomy, and 173 patients undergoing robotic gastrectomy. For each approach, the respective incidences were as follows: conversion to open surgery (not applicable, 0.4%, and 0%; p = 0.444), in-hospital major complications (5.8, 2.7, and 1.2%; p = 0.020), delayed complications requiring readmission (2.9, 2.0, and 1.2%; p = 0.453), positive resection margin (1.7, 0, and 0%; p = 0.003), and inadequate number of retrieved lymph nodes (0.4, 4.1, and 1.7%; p = 0.010). Compared with open and laparoscopic surgery, robotic gastrectomy had the highest surgical success rate (90, 90.8, and 96.0%). Learning-curve analysis of success using cumulative sum plots showed success with the robotic approach from the start. Multivariate analyses identified age, sex, and gastrectomy extent as significant independent parameters affecting surgical success. Surgical approach was not a contributing factor. Open, laparoscopic, and robotic gastrectomy exhibited different incidences and causes of surgical failure. Robotic gastrectomy produced the best surgical outcomes, although the approach method itself was not an independent factor for success.

  19. Effects of wearing lower leg compression sleeves on locomotion economy.

    Science.gov (United States)

    Kurz, Eduard; Anders, Christoph

    2018-09-01

    The purpose of this investigation was to assess the effect of compression sleeves on muscle activation cost during locomotion. Twenty-two recreationally active men (age: 25 ± 3 years) ran on a treadmill at four different speeds (ordered sequence of 2.8, 3.3, 2.2, and 3.9 m/s). The tests were performed without (control situation, CON) and while wearing specially designed lower leg compression sleeves (SL). Myoelectric activity of five lower leg muscles (tibialis anterior, fibularis longus, lateral and medial head of gastrocnemius, and soleus) was captured using Surface EMG. To assess muscle activation cost, the cumulative muscle activity per distance travelled (CMAPD) of the CON and SL situations was determined. Repeated measures analyses of variance were performed separately for each muscle. The analyses revealed a reduced lower leg muscle activation cost with respect to test situation for SL for all muscles (p  0.18). The respective significant reductions of CMAPD values during SL ranged between 4% and 16% and were largest at 2.8 m/s. The findings presented point towards an improved muscle activation cost while wearing lower leg compression sleeves during locomotion that have potential to postpone muscle fatigue.

  20. Elastic Knee Sleeves Limit Anterior Tibial Translation in Healthy Females

    Directory of Open Access Journals (Sweden)

    Robert Csapo, Simona Hosp, Ramona Folie, Robert Eberle, Michael Hasler, Werner Nachbauer

    2016-03-01

    Full Text Available Knee sleeves or braces represent auxiliary tools that have repeatedly been used by athletes, in an attempt to increase knee stability and, thus, reduce the risk of (recurrent ligamentous injuries. Since ACL injuries typically occur in situations involving either torsion or hyperextension of the knee, it has been speculated that braces might protect the ACL by countering excessive anterior translation of the tibia with respect to the femur (Beynnon et al., 1997. However, the preponderance of in vivo studies to test this hypothesis was performed in cohorts of patients suffering from existent ligamentous (Branch et al., 1988; Colville et al., 1986 or other knee injury (Beynnon et al., 1997; Fleming et al., 2000. This complicates the extrapolation of results to healthy subjects. Further, the braces used in these studies were mostly rigid constructs that consisted of either uni- or bilateral hinged bars (Rishiraj et al., 2009. Such braces might hinder performance (Veldhuizen et al., 1991 and would be rejected by the vast majority of healthy athletes. For these reasons, we would like to use this letter to the editor to report the results of our experiments investigating whether a relatively light elastic knee sleeve would limit the degree of anterior tibial translation in computerized arthrometry tests as performed in a sample of non-injured subjects. We recruited ten female college students (age: 23.4 ± 3.2 yrs, height: 1.68 ± 0.05 m, mass: 59.9 ± 5.5 kg who were free of acute or previous injury or any form of orthopaedic disease of the knee joints. The anterior displacement of the tibia was measured using the GNRB® computerized arthrometer (GeNouRob, Laval, France. With subjects lying in the supine position, the lower leg was firmly fixed with plastic caps mounted over the ankle joint and patella. An electrical pressure pad then exerted increasing pressure of up to 250 N on the calf, while a motion sensor, which was positioned on the ventral

  1. Sleeve push technique: A novel method of space gaining

    Directory of Open Access Journals (Sweden)

    Sanjeev Verma

    2018-01-01

    Full Text Available Space gaining is frequently required in orthodontics. Multiple loops were initially used for space gaining and alignment. The most common used mechanics for space gaining is the use of nickel–titanium open coil springs. The disadvantage of nickel–titanium coil spring is that they cannot be used until the arches are well aligned to receive the stiffer stainless steel wires. Therefore, a new method of gaining space during initial alignment and leveling has been developed and named as sleeve push technique (SPT. The nickel–titanium wires, i.e. 0.012 inches and 0.014 inches along with archwire sleeve (protective tubing can be used in a modified way to gain space along with alignment. This method helps in gaining space right from day 1 of treatment. The archwire sleeve and nickel–titanium wire in this new SPT act as a mutually synergistic combination and provide the orthodontist with a completely new technique for space opening.

  2. SCC testing of steam generator tubes repaired by welded sleeves

    International Nuclear Information System (INIS)

    Pierson, E.; Stubbe, J.

    1993-01-01

    One way to repair steam generator tubing is to introduce a sleeve inside the tube so that it spans the corroded area and to seal it at both ends. This technique has been studied at Laborelec with a particular attention paid to the occurrence of new SCC cracks at the upper joint. Tube segments coming from the same lot of mill annealed alloy 600 were sent to six manufacturers to be sleeved by their own procedure (including TIG, laser or kinetic welding, followed or not by a stress relief heat treatment), and then tested at Laborelecin 10% NaOH at 350 degrees C. The tests were performed with and without differential pressure i.e. in capsules (Δ = 9 and 19 MPa) and in autoclave (Δp = 0). Nearly all the not stress relieved mock-ups developed through cracks in several hundred hours in auto-clave. The cracks were circumferential and situated near the weld. At 9 and 19 MPa, the time to failure decreased and longitudinal cracks appeared near the weld and at the transition zone of expanded areas. Cracks were never observed in the alloy 690 sleeve, except in the weld bead. Reference capsules (roll expaned tubes) made of the same lot of alloy 600 were tested in the same environment

  3. Left lower lobe sleeve lobectomy for lung cancer using the Da Vinci surgical system.

    Science.gov (United States)

    Zhao, Yandong; Jiao, Wenjie; Ren, Xiaoyang; Zhang, Liangdong; Qiu, Tong; Fu, Bo; Wang, Lei

    2016-04-12

    Despite the robotic surgery is widely applied, sleeve lobectomy for lung cancer using the Da Vinci surgical system is still less performed. We described a sleeve lobectomy for adenocarcinoma located at the left lower lobe using the Da Vinci surgical system. A case of 57-year old female referred to our hospital. Computed tomography scan showed an occupation located at the left lower lobe and adenocarcinoma project from the lobe bronchus was diagnosed by bronchoscope examination. A sleeve lobectomy was performed using the Da Vinci surgical system and the postoperative recovery was uneventful. Robotic thoracic surgery is feasible to perform sleeve lobectomy inspite of inadequate experience.

  4. Retrograde Jejuno-Jejunal Intussusception after Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Akira Yoneda

    2008-08-01

    Full Text Available An eighty-year-old female was transferred to the hospital after experiencing abdominal pain and nausea. She had had a history of total gastrectomy for gastric cancer 14 years previously. Abdominal X-ray revealed a localized expansion of the small bowel. Computed tomography revealed a mass with a lamellar structure in a concentric circle. With a tentative diagnosis of small bowel obstruction due to intussusception, she underwent emergency operation. Laparotomy revealed a retrograde jejuno-jejunal intussusception. Bowel resection was performed due to the severe ischemic damage. All reported intussusception cases after total gastrectomy displayed retrograde characteristics and could occur both during the early and late period after surgery. It is important to consider the possibility of intussusception for patients presenting with acute abdomen who have previously undergone gastric resection.

  5. [Patients with gastric cancer submitted to gastrectomy: an integrative review].

    Science.gov (United States)

    Mello, Bruna Schroeder; Lucena, Amália de Fátima; Echer, Isabel Cristina; Luzia, Melissa de Freitas

    2010-12-01

    This study aims to analyze the scientific production about patients with gastric cancer submitted to gastrectomy and describe important aspects of nursing guidelines for these patients. An integrative review was carried out using Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases; twenty two articles were analyzed. Retrospective cross-sectional studies were the most frequent. The scientific production of nursing is numerically small in relation to the medical area. The results show that approaches related to pre and post-operative in gastrectomy for gastric cancer resection subsidize the knowledge of issues essential for nurses to promote efficient intervention for the recovery of such patients. There is still the need for further research on the practice of nursing in the guidelines of this kind of surgery.

  6. Splenectomy combined with gastrectomy and immunotherapy for advanced gastric cancer.

    Science.gov (United States)

    Miwa, H; Orita, K

    1983-06-01

    We studied the effects of a splenectomy in combination with immunotherapy on the survival of patients who had undergone a total gastrectomy. It was found that a splenectomy was not effective against advanced gastric cancer at stage III, and that the spleen should be retained for immunotherapy. Splenectomy for gastric cancer at terminal stage IV, particularly in combination with immunotherapy, produced not only augmentation of cellular immunity, but also increased survival.

  7. Strategic laparoscopic surgery for improved cosmesis in general and bariatric surgery: analysis of initial 127 cases.

    Science.gov (United States)

    Nguyen, Ninh T; Smith, Brian R; Reavis, Kevin M; Nguyen, Xuan-Mai T; Nguyen, Brian; Stamos, Michael J

    2012-05-01

    Strategic laparoscopic surgery for improved cosmesis (SLIC) is a less invasive surgical approach than conventional laparoscopic surgery. The aim of this study was to examine the feasibility and safety of SLIC for general and bariatric surgical operations. Additionally, we compared the outcomes of laparoscopic sleeve gastrectomy with those performed by the SLIC technique. In an academic medical center, from April 2008 to December 2010, 127 patients underwent SLIC procedures: 38 SLIC cholecystectomy, 56 SLIC gastric banding, 26 SLIC sleeve gastrectomy, 1 SLIC gastrojejunostomy, and 6 SLIC appendectomy. SLIC sleeve gastrectomy was initially performed through a single 4.0-cm supraumbilical incision with extraction of the gastric specimen through the same incision. The technique evolved to laparoscopic incisions that were all placed within the umbilicus and suprapubic region. There were no 30-day or in-hospital mortalities or 30-day re-admissions or re-operations. For SLIC cholecystectomy, gastric banding, appendectomy, and gastrojejunostomy, conversion to conventional laparoscopy occurred in 5.3%, 5.4%, 0%, and 0%, respectively; there were no major or minor postoperative complications. For SLIC sleeve gastrectomy, there were no significant differences in mean operative time and length of hospital stay compared with laparoscopic sleeve gastrectomy; 1 (3.8%) of 26 SLIC patients required conversion to five-port laparoscopy. There were no major complications. Minor complications occurred in 7.7% in the SLIC sleeve group versus 8.3% in the laparoscopic sleeve group. SLIC in general and bariatric operations is technically feasible, safe, and associated with a low rate of conversion to conventional laparoscopy. Compared with laparoscopic sleeve gastrectomy, SLIC sleeve gastrectomy can be performed without a prolonged operative time with comparable perioperative outcomes.

  8. A Multifactorial Analysis of Reconstruction Methods Applied After Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Oktay Büyükaşık

    2010-12-01

    Full Text Available Aim: The aim of this study was to evaluate the reconstruction methods applied after total gastrectomy in terms of postoperative symptomology and nutrition. Methods: This retrospective study was conducted on 31 patients who underwent total gastrectomy due to gastric cancer in 2. Clinic of General Surgery, SSK Ankara Training Hospital. 6 different reconstruction methods were used and analyzed in terms of age, sex and postoperative complications. One from esophagus and two biopsy specimens from jejunum were taken through upper gastrointestinal endoscopy from all cases, and late period morphological and microbiological changes were examined. Postoperative weight change, dumping symptoms, reflux esophagitis, solid/liquid dysphagia, early satiety, postprandial pain, diarrhea and anorexia were assessed. Results: Of 31 patients,18 were males and 13 females; the youngest one was 33 years old, while the oldest- 69 years old. It was found that reconstruction without pouch was performed in 22 cases and with pouch in 9 cases. Early satiety, postprandial pain, dumping symptoms, diarrhea and anemia were found most commonly in cases with reconstruction without pouch. The rate of bacterial colonization of the jejunal mucosa was identical in both groups. Reflux esophagitis was most commonly seen in omega esophagojejunostomy (EJ, while the least-in Roux-en-Y, Tooley and Tanner 19 EJ. Conclusion: Reconstruction with pouch performed after total gastrectomy is still a preferable method. (The Medical Bulletin of Haseki 2010; 48:126-31

  9. Is a sleeve lobectomy significantly better than a pneumonectomy?

    Science.gov (United States)

    Stallard, Joseph; Loberg, Anna; Dunning, Joel; Dark, John

    2010-11-01

    A best evidence topic was written according to a structured protocol. The question addressed was 'whether a sleeve lobectomy results in a better survival rate than a pneumonectomy in suitable patients?' Altogether, more than 327 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude in the biggest meta-analysis of nearly 3000 patients, the five-year survival was 50% for sleeve lobectomy compared to 30% for pneumonectomy. Operative mortality was 3% vs. 6% for pneumonectomy, and locoregional recurrence was 17% vs. 30%. These results are broadly consistent across all the 13 cohort studies presented here many of which document a 20-year single centre experience or more. There are significant issues in all cohort studies on this subject as, due to their non-randomized nature, the reason for not performing a sleeve resection may well have been more advanced disease, which would necessarily mean that the pneumonectomy patients would have a lower expected survival and higher local recurrence. In addition, there have been many large cohort studies to date and thus no more are required, as future studies are unlikely to resolve this issue. Thus, the only study that would adequately correct for this issue would be a randomized trial, but to prove a 10% increase in five-year survival a 300 patient study would be needed. This is bigger than any study ever done in this area and as some centres took 30 years to collect these numbers of potential sleeve patients an RCT is not a realistic possibility. Therefore, we conclude that no more cohort studies should be performed, as the results will be consistent with the meta-analyses and an RCT to eliminate their bias is unattainable, and thus no more research should be done on this topic and surgeons should use

  10. Use of color-coded sleeve shutters accelerates oscillograph channel selection

    Science.gov (United States)

    Bouchlas, T.; Bowden, F. W.

    1967-01-01

    Sleeve-type shutters mechanically adjust individual galvanometer light beams onto or away from selected channels on oscillograph papers. In complex test setups, the sleeve-type shutters are color coded to separately identify each oscillograph channel. This technique could be used on any equipment using tubular galvanometer light sources.

  11. Feasibility and profitability of chain integration by NCPAK on flower sleeves products in European market

    NARCIS (Netherlands)

    Yan, X.

    2008-01-01

    In this report, the author describes that the EU flower sleeve wholesalers are the chain leader of the flower sleeve supply chain from China to the EU market. Their strategy changes can easily put NCpak, in full name, 'Sun Hing Plastic Bag Company', a Hong Kong enterprise based on Shenzhen City,

  12. Safety and feasibility of minimally invasive gastrectomy during the early introduction in the Netherlands: short-term oncological outcomes comparable to open gastrectomy.

    Science.gov (United States)

    Brenkman, H J F; Ruurda, J P; Verhoeven, R H A; van Hillegersberg, R

    2017-09-01

    Minimally invasive techniques for gastric cancer surgery have recently been introduced in the Netherlands, based on a proctoring program. The aim of this population-based cohort study was to evaluate the short-term oncological outcomes of minimally invasive gastrectomy (MIG) during its introduction in the Netherlands. The Netherlands Cancer Registry identified all patients with gastric adenocarcinoma who underwent gastrectomy with curative intent between 2010 and 2014. Multivariable analysis was performed to compare MIG and open gastrectomy (OG) on lymph node yield (≥15), R0 resection rate, and 1-year overall survival. The pooled learning curve per center of MIG was evaluated by groups of five subsequent procedures. Between 2010 and 2014, a total of 277 (14%) patients underwent MIG and 1633 (86%) patients underwent OG. During this period, the use of MIG and neoadjuvant chemotherapy increased from 4% to 39% (p introduction of minimally invasive gastrectomy in Western countries is feasible and can be performed safely.

  13. PLUSS-A weldless leaktight sleeve for alloy 600/690 steam generator tubes

    International Nuclear Information System (INIS)

    Potz, F.; Bohmann, W.

    1998-01-01

    The ABB PLUSS sleeving represents a new SG tube repair technique qualified and approved to replace in the future most of the plugging as well as welded sleeving. Basically the advantages of an innovative combination of both alloys 600/690 and 800 are taken into consideration. The upper sleeve/SG tube-joint is hydraulically expanded stressing the SG tube only within the elastic range. The lower joint is hard rolled. The installation processes are simple and reproducible, fast, computerized and individually recorded. The operating temperature range of the sleeved SG-tube is effectively reduced so that any further corrosion is impeded. Both, sleeve and SG tube are fully inspectable by ECT. (author)

  14. Fretting and Corrosion Damage in Taper Adapter Sleeves for Ceramic Heads: A Retrieval Study.

    Science.gov (United States)

    MacDonald, Daniel W; Chen, Antonia F; Lee, Gwo-Chin; Klein, Gregg R; Mont, Michael A; Kurtz, Steven M; Cates, Harold E; Kraay, Matthew J; Rimnac, Clare M

    2017-09-01

    During revision surgery with a well-fixed stem, a titanium sleeve can be used in conjunction with a ceramic head to achieve better stress distribution across the taper surface. In vitro testing suggests that corrosion is not a concern in sleeved ceramic heads; however, little is known about the in vivo fretting corrosion of the sleeves. The purpose of this study was to investigate fretting corrosion in sleeved ceramic heads in retrieved total hip arthroplasties. Thirty-seven sleeved ceramic heads were collected during revision. The femoral heads and sleeves were implanted 0.0-3.3 years. The implants were revised predominantly for instability, infection, and loosening. Fifty percent of the retrievals were implanted during a primary surgery. Fretting corrosion was assessed using the Goldberg-Higgs semiquantitative scoring system. Mild-to-moderate fretting corrosion scores (score = 2-3) were observed in 92% of internal tapers, 19% of external tapers, and 78% of the stems. Severe fretting corrosion was observed in 1 stem trunnion that was previously retained during revision surgery and none of the retrieved sleeves. There was no difference in corrosion damage of sleeves used in primary or revision surgery. The fretting corrosion scores in this study were predominantly mild and lower than reported fretting scores of cobalt-chrome heads in metal-on-polyethylene bearings. Although intended for use in revisions, we found that the short-term in vivo corrosion behavior of the sleeves was similar in both primary and revision surgery applications. From an in vivo corrosion perspective, sleeves are a reasonable solution for restoring the stem taper during revision surgery. Copyright © 2017. Published by Elsevier Inc.

  15. Laparoscopic Gastric Sleeve and Micronutrients Supplementation: Our Experience

    Directory of Open Access Journals (Sweden)

    D. Capoccia

    2012-01-01

    Full Text Available Background. Laparoscopic gastric sleeve (LGS has been recently introduced as a stand-alone, restrictive bariatric surgery. Theoretically, LGS attenuates micronutrients deficiencies and associated complications that were typically observed following malabsorptive procedures. The aim of this study was to assess some micronutrients and mineral deficiencies in patients undergoing LGS. Methods. In the period between July 2008 and April 2010, 138 obese patients (110 females and 28 males with mean BMI 44.4 kg/m2 ± 6.5, mean age 43.9±10.9 years were enrolled and underwent LGS. Patients were followed up with routine laboratory tests and anthropometric measurements and assessed for nutritional status, as regards vitamin B12, folic acid, iron, hemoglobin, calcium, and vitamin D, every three months throughout 12 months. Results. 12 months after sleeve, patients did not show iron deficiency and/or anemia; plasma calcium levels were in the normal range without supplementation from the sixth month after the operation. Vitamin B12 and folic acid were adequately supplemented for all the follow-up period. Vitamin D was in suboptimal levels, despite daily multivitamin supplementation. Conclusion. In this study, we showed that LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrients deficiencies and greater weight loss does not require higher dosage of multivitamins.

  16. Abdominal drainage versus no drainage post gastrectomy for gastric cancer.

    Science.gov (United States)

    Wang, Zhen; Chen, Junqiang; Su, Ka; Dong, Zhiyong

    2011-08-10

    Gastrectomy remains the primary therapeutic method for resectable gastric cancer. Thought of as an important measure to reduce post-operative complications and mortality, abdominal drainage was used widely after gastrectomy for gastric cancer in previous decades. The benefits of abdominal drainage have been questioned by researchers in recent years. The objectives of this review were to access the benefits and harms of routine abdominal drainage post gastrectomy for gastric cancer. We searched the Cochrane Controlled Trials Register (Central/CCTR) in The Cochrane Library (2010, Issue 10), including the Specialised Registers of the Cochrane Upper Gastrointestinal and Pancreatic Diseases (UGPD) Group; MEDLINE (via Pubmed, 1950 to October, 2010); EMBASE (1980 to October, 2010); and the Chinese National Knowledge Infrastructure (CNKI) Database (1979 to October, 2010). We included randomised controlled trials (RCTs) comparing abdominal drain versus no drain in patients who had undergone gastrectomy (not considering the scale of gastrectomy and the extent of lymphadenectomy; irrespective of language, publication status, and the type of drain). We excluded RCTs comparing one drain with another. From each trial, we extracted the data on the methodological quality and characteristics of the included studies, mortality (30-day mortality), re-operations, post-operative complications (pneumonia, wound infection, intra-abdominal abscess, anastomotic leak, drain-related complications), operation time, length of post-operative hospital stay and initiation of soft diet. For dichotomous data, we calculated the risk ratio (RR) and 95% confidence intervals (CI). For continuous data, we calculated mean differences (MD) and 95% CI. We tested heterogeneity using the Chi(2) test. We used a fixed-effect model for data analysis with RevMan software but we used a random-effects model if the P value of the Chi(2) test was less than 0.1. We included four RCTs involving 438 patients (220

  17. Nutritional Status After Total Gastrectomy for Gastric Cancer.

    Science.gov (United States)

    Cidon, Esther Una

    2010-04-01

    Gastric cancer is one of the most frequent causes of death secondary to cancer in the world. Surgery is the only potentially curative treatment but its clinical consequences are significant. The objective of this study is to evaluate the nutritional state of patients with a total gastrectomy secondary to gastric adenocarcinoma. We designed a descriptive study with a transversal cut in our institution. We included 22 patients which had a minimum evolution time of six months after total gastrectomy secondary to gastric cancer surgery was performed. Neither of them had metastasis. The nutritional analysis included only biochemical data. Descriptive statistics were used for statistical analysis. Eight females and 14 males were included in the study. Median age was 57 years (34 - 69 years). The 74% of the patients were underweight and none of them was overweight. The average body mass index (BMI) was 16.88 kg/m 2 . Eleven patients suffered from mild anemia (10.5 - 12 g/dl) and 5 from moderate anemia (9 - 10.5 g/dl). Only two patients presented severe anemia (less than 9 g/dl). The 58% presented hypoproteinaemia and hypoalbuminaemia. The main post-surgery complication was nausea (46%). Seventy-eight percent of the patients had loss of appetite. Twenty-one patients were able to walk without help and leave their homes. The incidence of anemia in these patients was very high. In most of the patients, albumin and proteins levels were affected too. So malnutrition was a relevant consequence of a total gastrectomy.

  18. Duodenal fistula after gastrectomy: retrospective study of 13 new cases

    Directory of Open Access Journals (Sweden)

    María de los Ángeles Cornejo

    2016-01-01

    Full Text Available Introduction: Duodenal stump fistula (DSF after gastrectomy has a low incidence but a high morbidity and mortality, and is therefore one of the most aggressive and feared complications of this procedure. Material and methods: We retrospectively evaluated all DSF occurred at our hospital after carrying out a gastrectomy for gastric cancer, between January 1997 and December 2014. We analyzed demographic, oncologic, and surgical variables, and the evolution in terms of morbidity, mortality and hospital stay. Results: In the period covered in this study, we performed 666 gastrectomies and observed DSF in 13 patients (1.95%. In 8 of the 13 patients (61.5% surgery was the treatment of choice and in 5 cases (38.5% conservative treatment was carried out. Postoperative mortality associated with DSF was 46.2% (6 cases. In the surgical group, 3 patients developed severe sepsis with multiple organ failure, 2 patients presented a major hematemesis which required endoscopic haemostasis, 1 patient had an evisceration and another presented a subphrenic abscess requiring percutaneous drainage. Six patients (75% died despite surgery, with 3 deaths in the first 24 hours of postoperative care. The 2 patients who survived after the second surgical procedure had a hospital stay of 45 and 84 days respectively. In the conservative treatment group the cure rate was 100% with no significant complications and an average postoperative hospital stay of 39.5 days (range, 26-65 days. Conclusion: FMD is an unusual complication but it is associated with a high morbidity and mortality. In our experience, conservative management has shown better results compared with surgical treatment.

  19. Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy

    Directory of Open Access Journals (Sweden)

    Lee Sang-Woong

    2012-12-01

    Full Text Available Abstract Background Laparoscopic gastrectomy has recently been gaining popularity as a treatment for cancer; however, little is known about the benefits of intracorporeal (IC gastrointestinal anastomosis with pure laparoscopic distal gastrectomy (LDG compared with extracorporeal (EC anastomosis with laparoscopy-assisted distal gastrectomy (LADG. Methods Between June 2000 and December 2011, we assessed 449 consecutive patients with early-stage gastric cancer who underwent LDG. The patients were classified into three groups according to the method of reconstruction LADG followed by EC hand-sewn anastomosis (LADG + EC (n = 73, using any of three anastomosis methods (Billroth-I (B-I, Billroth-II (B-II or Roux-en-Y (R-Y; LDG followed by IC B-I anastomosis (LDG + B-I (n = 248; or LDG followed by IC R-Y anastomosis (LDG + R-Y (n = 128. The analyzed parameters included patient and tumor characteristics, operation details, and post-operative outcomes. Results The tumor location was significantly more proximal in the LDG + R-Y group than in the LDG + B-I group (P P P  Conclusions Intracorporeal mechanical anastomosis by either the B-I or R-Y method following LDG has several advantages over at the LADG + EC, including small wound size, reduced invasiveness, and safe anastomosis. Although additional randomized control studies are warranted to confirm these findings, we consider that pure LDG is a useful technique for patients with early gastric cancer.

  20. Study on grout-filled coupling steel sleeve; Kokan sleeve wo mochiita grout jutenshiki tekkin tsugite ni kansuru kenkyu

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Y. [Osaka University, Osaka (Japan)

    1997-06-01

    Newly designed grout-filled coupling sleeve is discussed, which uses as the sleeve an electric resistance welded tube with protrusions formed in a checker pattern on its inner wall and is capable of using various premixed grouting materials available on the market. Specimens are subjected to uniaxial tensile loading and positive/negative cyclic loading, and the impact of various factors on the basic performance of the specimens and their stress/distortion characteristics at local spots in the reinforcing bar are disclosed. In the positive/negative cyclic loading in the plastic region, however, such findings are not obtained. In view of the stress/distortion characteristics at local spots in the reinforcing bar, a method is proposed for estimating the coupling strength and fracture type. A method for estimating the deformation behavior of the coupling, however, is not proposed. Investigations are conducted into the manufacture and installation of the grout holding framework, coupling fixing jigs, plugs, etc., and it is found that precasting should be studied in the future. 38 refs., 156 figs., 30 tabs.

  1. Early enteral nutrition after total gastrectomy for gastric cancer.

    Science.gov (United States)

    Chen, Wei; Zhang, Zheng; Xiong, Maoming; Meng, Xiangling; Dai, Fen; Fang, Jun; Wan, Hong; Wang, Miaofeng

    2014-01-01

    To assess the difference between early enteral nutrition (EEN group) and total parenteral nutrition (TPN group) after total gastrectomy for gastric cancer. The nutrition index, liver function, patient generated subjective global assessment (PG-SGA) score, the post-operation complications, the hospital stay and hospitalization expense of the postoperative patient after total gastrectomy, admitted to our Department of Surgery from May 2011 to May 2013 were analyzed retrospectively. A total of 72 patients including 37 cases in the EEN group and 35 cases in the TPN group were recruited. Hypoalbuminemia gradually improved in the EEN group about 3-5 days, but it did not increase until average 21 days in the TPN group. The body weight decreased in the EEN group during the first 2 weeks and recovered gradually in 21 days; body weight in the TPN group was significantly lower than the EEN group at 21 days (pnutrition indicators. The incidence of complications in the EEN group and TPN group were 8.1% and 25.7% respectively, with no significant differences (p>0.05). The days of hospital stays in the EEN and in the TPN group were up to 12.2 ± 2.5 d vs 14.9 ± 2.9 d (pgastric cancer.

  2. Radionuclide methods in estimating after-effects of gastrectomy for cancer

    Energy Technology Data Exchange (ETDEWEB)

    Saenko, A I; Bespalov, I I; Modnikov, O P [Kirgizskij Nauchno-Issledovatel' skij Inst. Onkologii i Radiologii, Frunze (USSR)

    1981-01-01

    The fat, protein and B/sub 12/ absorption by the liver, kidney and, small intestine was studied by radionuclide methods in gastric cancer patients during the preoperative period as well as within 15-30 days, 3-12 months and for more than a year following gastrectomy. It was observed that the function of the kidney, liver and B/sub 12/ absorption was disturbed during the preoperative period. Gastrectomy caused a marked depression of the renal, hepatic and small intestinal function. During later periods following gastrectomy, these functions improved but were not restored to normal.

  3. Experimental and numerical studies of various thermal sleeves subjected to severe cyclic thermal shocks

    International Nuclear Information System (INIS)

    Masson, J.C.; Moinereau, D.

    1990-01-01

    During the first operating years of nuclear power plants of different countries, damage was encountered on thermal sleeves used as nozzle protection. Following this discovery studies were initiated to determine the causes and to find solutions. At first a problem of vibration was found and easily solved by reducing gaps and reinforcing the welding of the sleeves. But preliminary tests with cyclic thermal shocks showed a risk of fatigue crack initiation and propagation both in the sleeve fixation and in the nozzle. Therefore a large research and development program was led principally by EDF laboratories of Les Renardieres, to demonstrate the absence of nocivity of thermal shocks during the plants life time [fr

  4. Validation of sleeve of straight union type B for leaks

    Energy Technology Data Exchange (ETDEWEB)

    Teutonico, Mauricio; Fazzini, Pablo [Gie S.A., Buenos Aires (Argentina)

    2009-07-01

    Analytic study and experimental validation of type B sleeve with overlapping, were done in order to determine whether they are suitable for used as permanent leaks repair in hydrocarbons transport lines. All relevant background of this type of repair was analyzed, following the guidelines defined by applicable regulations (ASME B31.8 and ASME B31.4) and modeled by finite elements methods. Solicitations under internal pressure of each one of the reinforcement parts were analyzed. All solicitations involved in welded unions were studied, so as the reinforcement effectiveness when it is filled with internal gap filler. Experimental tests were developed, consisted on the reinforcement installation upon damaged pipes and the following hydrostatic test. These tests were assisted by a digitalized measurement, to determine the solicitations at different parts of the reinforcement; strain gauges were used for this task. (author)

  5. TAPIR, Thermal Analysis of HTGR with Graphite Sleeve Fuel Elements

    International Nuclear Information System (INIS)

    Weicht, U.; Mueller, W.

    1983-01-01

    1 - Nature of the physical problem solved: Thermal analysis of a reactor core containing internally and/or externally gas cooled prismatic fuel elements of various geometries, rating, power distribution, and material properties. 2 - Method of solution: A fuel element in this programme is regarded as a sector of a fuelled annulus with graphite sleeves of any shape on either side and optional annular gaps between fuel and graphite and/or within the graphite. It may have any centre angle and the fuelled annulus may become a solid cylindrical rod. Heat generation in the fuel is assumed to be uniform over the cross section and peripheral heat flux into adjacent sectors is ignored. Fuel elements and coolant channels are treated separately, then linked together to fit a specified pattern. 3 - Restrictions on the complexity of the problem: Maxima of: 50 fuel elements; 50 cooled channels; 25 fuel geometries; 25 coolant channel geometries; 10 axial power distributions; 10 graphite conductivities

  6. Postoperative Quality of Life after Total Gastrectomy Compared with Partial Gastrectomy: Longitudinal Evaluation by European Organization for Research and Treatment of Cancer-OG25 and STO22.

    Science.gov (United States)

    Lee, Jeong-Hwan; Lee, Hyuk-Joon; Choi, Yun Suk; Kim, Tae Han; Huh, Yeon-Ju; Suh, Yun-Suhk; Kong, Seong-Ho; Yang, Han-Kwang

    2016-12-01

    The European Organization for Research and Treatment of Cancer quality-of-life questionnaire-OG25 was developed to evaluate the quality of life in patients with stomach and esophageal cancer. The following are included in the OG25 but not in the STO22: odynophagia, choked when swallowing, weight loss, trouble eating with others, trouble swallowing saliva, trouble talking, and trouble with coughing. In this study, we evaluated the quality of life of gastrectomized patients using both, the OG25 and the STO22. A total of 138 patients with partial gastrectomy (PG) (distal gastrectomy=91; pylorus-preserving gastrectomy= 47) and 44 patients with total gastrectomy (TG) were prospectively evaluated. Body weight and scores from the OG25 and STO22 were evaluated preoperatively and at 3 weeks, 3 months, and 6 months after surgery. Patients with TG had significant weight loss compared to patients with PG. At 3 months, TG was associated with worse scores for dysphagia, eating, odynophagia, trouble eating with others, trouble with taste, and weight loss on the OG25. TG was also associated with dysphagia, eating restrictions, and anxiety on the STO22. The OG25 helped differentiate between the groups with respect to weight loss, odynophagia, choked when swallowing, and trouble eating with others. The OG25 scores changed over time and were significantly different. The OG25 is a more sensitive and useful scale than the STO22 for evaluating the quality of life of gastrectomized patients, especially those with total gastrectomy.

  7. Selective beneficial cardiometabolic effects of vertical sleeve gastrectomy are predominantly mediated through glucagon-like peptide (GLP-1 in Zucker diabetic fatty rats

    Directory of Open Access Journals (Sweden)

    Sunil Kumar

    2016-12-01

    Conclusion: Enhanced GLP-1 secretion post VSG imparted beneficial cardiometabolic effects on blood glucose, insulin, total cholesterol, triglyceride, bile acids and L-PGDS levels which were abated in the presence of GLP-1 antagonist.

  8. Roux-En-Y gastric bypass and sleeve gastrectomy does not affect food preferences when assessed by an ad libitum buffet meal

    DEFF Research Database (Denmark)

    Nielsen, Mette Søndergaard; Christensen, Bodil Just; Ritz, Christian

    2017-01-01

    reports, which may be prone to recall bias and underestimation of especially unhealthy foods. METHODS: Using an ad libitum buffet meal targeting direct behavior, we investigated if RYGB and SG surgery leads to changes in food preferences. In addition, we assessed food preferences by a picture display test...... to explore differences between a method relying on verbal report and a method assessing direct behavior. RESULTS: Forty-one subjects (BMI 45.0 ± 6.8 kg/m(2)) completed a visit pre- and 6 months post-RYGB (n = 31) and SG (n = 10). Mean BMI decreased with 11.7 ± 0.6 kg/m(2) and total energy intake...

  9. [Post-gastrectomy reconstruction versus enteral alimentation--a one year follow-up study].

    Science.gov (United States)

    Kostov, D; Balabanova, G; Vasilev, B; Plachkov, I; Ignatov, G

    2000-01-01

    This is a report on various post-gastrectomy reconstructive procedures, proceeding from personal experience had with 14 patients undergoing gastrectomy for carcinoma of the stomach and five patients with operations of esophagus and stomach for various pathological conditions. An assessment is done of the reconstructive methods used on the ground of objective indicators. All patients are subjected to enteral alimentation through nutritive jejunostomy. In the pre- and postoperatived periods, the trophic state of patients is evaluated on basis of biochemical, anthropometric and immunologic study data. Postoperatively, in those with small-intestinal reservoir a lower degree negative symptomatology is established, along with life style improvement. Post-gastrectomy patients presenting I-II (UICC) stage of the oncological disease are indicated for small-intestinal reservoir formation. In the overall therapeutic approach to post-gastrectomy patients adequate clinical therapeutic feeding proves absolutely indispensable.

  10. Management of post-gastrectomy anastomosis site obstruction with a self-expandable metallic stent.

    Science.gov (United States)

    Cha, Ra Ri; Lee, Sang Soo; Kim, Hyunjin; Kim, Hong Jun; Kim, Tae-Hyo; Jung, Woon Tae; Lee, Ok Jae; Bae, Kyung Soo; Jeong, Sang-Ho; Ha, Chang Yoon

    2015-04-28

    Post-gastrectomy anastomosis site obstruction is a relatively rare complication after a subtotal gastrectomy. We present a case of a 75-year-old man who underwent a truncal vagotomy, omental patch, gastrojejunostomy, and Braun anastomosis for duodenal ulcer perforation and a gastric outlet obstruction. Following the 10(th) postoperative day, the patient complained of abdominal discomfort and vomiting. We diagnosed post-gastrectomy anastomosis site obstruction by an upper gastrointestinal series and an upper endoscopic examination. We inserted a self-expandable metallic stent (SEMS) at the anastomosis site. The stent was fully expanded after deployment. On the day following the stent insertion, the patient began to eat, and his abdominal discomfort was resolved. This paper describes the successful management of post-gastrectomy anastomosis site obstruction with temporary placement of a SEMS.

  11. Development of on line automatic separation device for apple and sleeve

    Science.gov (United States)

    Xin, Dengke; Ning, Duo; Wang, Kangle; Han, Yuhang

    2018-04-01

    Based on STM32F407 single chip microcomputer as control core, automatic separation device of fruit sleeve is designed. This design consists of hardware and software. In hardware, it includes mechanical tooth separator and three degree of freedom manipulator, as well as industrial control computer, image data acquisition card, end effector and other structures. The software system is based on Visual C++ development environment, to achieve localization and recognition of fruit sleeve with the technology of image processing and machine vision, drive manipulator of foam net sets of capture, transfer, the designated position task. Test shows: The automatic separation device of the fruit sleeve has the advantages of quick response speed and high separation success rate, and can realize separation of the apple and plastic foam sleeve, and lays the foundation for further studying and realizing the application of the enterprise production line.

  12. Design of a Soft Robotic Elbow Sleeve with Passive and Intent-Controlled Actuation

    Directory of Open Access Journals (Sweden)

    Tze Hui Koh

    2017-10-01

    Full Text Available The provision of continuous passive, and intent-based assisted movements for neuromuscular training can be incorporated into a robotic elbow sleeve. The objective of this study is to propose the design and test the functionality of a soft robotic elbow sleeve in assisting flexion and extension of the elbow, both passively and using intent-based motion reinforcement. First, the elbow sleeve was developed, using elastomeric and fabric-based pneumatic actuators, which are soft and lightweight, in order to address issues of non-portability and poor alignment with joints that conventional robotic rehabilitation devices are faced with. Second, the control system was developed to allow for: (i continuous passive actuation, in which the actuators will be activated in cycles, alternating between flexion and extension; and (ii an intent-based actuation, in which user intent is detected by surface electromyography (sEMG sensors attached to the biceps and triceps, and passed through a logic sequence to allow for flexion or extension of the elbow. Using this setup, the elbow sleeve was tested on six healthy subjects to assess the functionality of the device, in terms of the range of motion afforded by the device while in the continuous passive actuation. The results showed that the elbow sleeve is capable of achieving approximately 50% of the full range of motion of the elbow joint among all subjects. Next, further experiments were conducted to test the efficacy of the intent-based actuation on these healthy subjects. The results showed that all subjects were capable of achieving electromyography (EMG control of the elbow sleeve. These preliminary results show that the elbow sleeve is capable of carrying out continuous passive and intent-based assisted movements. Further investigation of the clinical implementation of the elbow sleeve for the neuromuscular training of neurologically-impaired persons, such as stroke survivors, is needed.

  13. Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

    OpenAIRE

    Portanova Michel

    2010-01-01

    Abstract Background Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Methods Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent to...

  14. Modeling and testing of a knitted-sleeve fluidic artificial muscle

    Science.gov (United States)

    Ball, Erick J.; Meller, Michael A.; Chipka, Jordan B.; Garcia, Ephrahim

    2016-11-01

    The knitted-sleeve fluidic muscle is similar in design to a traditional McKibben muscle, with a separate bladder and sleeve. However, in place of a braided sleeve, it uses a tubular-knit sleeve made from a thin strand of flexible but inextensible yarn. When the bladder is pressurized, the sleeve expands by letting the loops of fiber slide past each other, changing the dimensions of the rectangular cells in the stitch pattern. Ideally, the internal volume of the sleeve would reach a maximum when its length has contracted by 2/3 from its maximum length, and although this is not reachable in practice, preliminary tests show that free contraction greater than 50% is achievable. The motion relies on using a fiber with a low coefficient of friction in order to reduce hysteresis to an acceptable level. In addition to increased stroke length, potential advantages of this technique include slower force drop-off during the stroke, more useable energy in certain applications, and greater similarity to the force-length relationship of skeletal muscle. Its main limitation is its potentially greater effect from friction compared to other fluidic muscle designs.

  15. Root cause analysis of SI line-seated thermal sleeve separation failures

    International Nuclear Information System (INIS)

    Jo, Jong Chull; Jhung, Myung Jo; Kim, Hho Jung

    2004-01-01

    At conventional pressurized water reactors, a thermal sleeve (named simply 'sleeve' hereafter) is seated inside the nozzle part of each Safety Injection (SI) branch pipe to prevent and relieve potential excessive transient thermal stress in the nozzle wall when a cold water is injected during the safety injection mode Recently, mechanical failures that the sleeves are separated from the SI branch pipe and fall into the connected cold leg main pipe were occurred in sequence at Yonggwang units 5 and 6 and Ulchin unit 5. There were many activities and efforts to figure out the causes of those failures with experts' reasoning, but the proposed causes were derived from superficial views rather than physically concrete grounds or analysis results. The prerequisites to find out the root causes of failure mechanism will be to identify the flow situation in the pipe junction area connecting the cold leg with the SI pipe and to know the vibration characteristics of sleeves. This paper investigates the flow field in the pipe junction thru a numerical simulation and vibration characteristics of thermal sleeves thru a modal analysis, from which the root causes of sleeve separation mechanism are analyzed

  16. Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional and oncological outcomes.

    Science.gov (United States)

    Nakauchi, Masaya; Suda, Koichi; Nakamura, Kenichi; Shibasaki, Susumu; Kikuchi, Kenji; Nakamura, Tetsuya; Kadoya, Shinichi; Ishida, Yoshinori; Inaba, Kazuki; Taniguchi, Keizo; Uyama, Ichiro

    2017-11-01

    Higher morbidity in total gastrectomy than in distal gastrectomy has been reported, but laparoscopic subtotal gastrectomy (LsTG) has been reported to be safe and feasible in early gastric cancer (GC). We determined the surgical, nutritional and oncological outcomes of LsTG for advanced gastric cancer (AGC). Of the 816 consecutive patients with GC who underwent radical gastrectomy at our institution between 2008 and 2012, 253 who underwent curative laparoscopic gastrectomy (LG) for AGC were enrolled. LsTG was indicated for patients with upper stomach third tumors, who hoped to avoid total gastrectomy, nutritional status were primarily assessed. Of 253 patients, the morbidity (Clavien-Dindo classification grade ≥ III) was 17.0% (43 patients). The 3-year overall survival and 3-year recurrence-free survival rates were 80.2 and 73.5%, respectively. LcDG, LsTG and LTG were performed in 121, 27 and 105 patients, individually. Morbidity was strongly associated with LTG (P = 0.001). Postoperative loss of body weight was significantly greater after LTG in comparison with LcDG or LsTG (P nutritional point of view.

  17. Long-Term Trends in Hematological and Nutritional Status After Gastrectomy for Gastric Cancer.

    Science.gov (United States)

    Kim, Ji-Hyun; Bae, You-Jin; Jun, Kyong-Hwa; Chin, Hyung-Min

    2017-08-01

    This study investigated long-term trends in hematological and nutritional parameters after gastrectomy for gastric cancer and evaluated the influence of the reconstruction type on these trends. The medical records of 558 patients who underwent curative gastrectomy with standard lymph node dissection for stage I gastric cancer between January 2006 and December 2013 were reviewed. The hematological and nutritional parameters evaluated included hemoglobin, ferritin, vitamin B 12 , total protein, albumin, total cholesterol, triglyceride, and calcium. The patients were followed up for 6 months postoperatively and then annually until death, cancer recurrence, or follow-up loss. In the long term, ferritin and triglyceride gradually decreased after gastrectomy, while the other parameters decreased slightly or were stable. In the comparisons according to reconstruction type, the Roux-en-Y group had the lowest levels of hemoglobin, ferritin, vitamin B12, total protein, albumin, and total cholesterol beginning 6 months postoperatively compared with the Billroth I and II groups. However, only ferritin and vitamin B 12 had significant differences in the 5-year cumulative incidences of deficiency/reduction according to the reconstruction type, whereas albumin, triglyceride, total cholesterol, and calcium did not. Although malabsorption and malnutrition are common in patients after a gastrectomy, most nutritional parameters were stable or decreased slightly in the long-term and were not markedly influenced by the reconstruction type or extent of gastrectomy. Therefore, for more accurate nutritional assessment after gastrectomy, multidirectional monitoring should be considered rather than simply measuring biochemical parameters.

  18. Acquired omental cystic lymphangioma after subtotal gastrectomy: a case report.

    Science.gov (United States)

    Kim, Jong Han; Ryu, Woo Sang; Min, Byung Wook; Song, Tae Jin; Son, Gil Soo; Kim, Seung Joo; Kim, Young Sik; Um, Jun Won

    2009-12-01

    We herein describe a case of cystic lymphangioma in the greater omentum of the remnant stomach, which is thought it to be related with subtotal gastrectomy 10 yr ago for early gastric cancer. A 76-yr-old man was admitted to our department with postprandial abdominal discomfort and bowel habit change. Intraabdominal multilocular cystic mass was detected by ultrasonography and computed tomography. We performed a complete En-bloc tumor resection including spleen and distal pancreas, and histological examination confirmed cystic lymphangioma originated from the greater omentum of the remnant stomach. Although the etiology of omental lymphangioma remains largely unclear, these findings suggested strongly that obstruction of the lymphatic vessels after gastric resection for gastric carcinoma might be the most plausible cause. The surgical extirpation with resection of organs involved appears to be a treatment of choice for such unusual case.

  19. Prophylactic total gastrectomy in hereditary diffuse gastric cancer

    DEFF Research Database (Denmark)

    Bardram, Linda; Hansen, Thomas V O; Gerdes, Anne-Marie

    2014-01-01

    Inactivating mutations in the CDH1 (E-cadherin) gene are the predisposing cause of gastric cancer in most families with hereditary diffuse gastric cancer (HDGC). The lifetime risk of cancer in mutation positive members is more than 80 % and prophylactic total gastrectomy is recommended. Not all...... mutations in the CDH1 gene are however pathogenic and it is important to classify mutations before this major operation is performed. Probands from two Danish families with gastric cancer and a history suggesting HDGC were screened for CDH1 gene mutations. Two novel CDH1 gene mutations were identified....... Hospital stay was 6-8 days and there were no complications. Small foci of diffuse gastric cancer were found in all patients-intramucosal in six and advanced in one. Preoperative endoscopic biopsies had revealed a microscopic cancer focus in two of the patients. Our data confirmed the pathogenic nature...

  20. Entirely Laparoscopic Gastrectomy and Colectomy for Remnant Gastric Cancer with Gastric Outlet Obstruction and Transverse Colon Invasion

    OpenAIRE

    Kim, Hyun Il; Kim, Min Gyu

    2015-01-01

    It is well known that gastrectomy with curative intent is the best way to improve outcomes of patients with remnant gastric cancer. Recently,several investigators reported their experiences with laparoscopic gastrectomy of remnant gastric cancer. We report the case of an 83-year-old female patient who was diagnosed with remnant gastric cancer with obstruction. She underwent an entirely laparoscopic distal gastrectomy with colectomy because of direct invasion of the transverse colon. The opera...

  1. Reconstruction of the esophagojejunostomy by double stapling method using EEA™ OrVil™ in laparoscopic total gastrectomy and proximal gastrectomy

    Directory of Open Access Journals (Sweden)

    Yano Seiji

    2011-05-01

    Full Text Available Abstract Here we report the method of anastomosis based on double stapling technique (hereinafter, DST using a trans-oral anvil delivery system (EEATM OrVilTM for reconstructing the esophagus and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection. As a basic technique, laparoscopic total gastrectomy employed Roux-en-Y reconstruction, laparoscopic proximal gastrectomy employed double tract reconstruction, and end-to-side anastomosis was used for the cut-off stump of the esophagus and lifted jejunum. We used EEATM OrVilTM as a device that permitted mechanical purse-string suture similarly to conventional EEA, and endo-Surgitie. After the gastric lymph node dissection, the esophagus was cut off using an automated stapler. EEATM OrVilTM was orally and slowly inserted from the valve tip, and a small hole was created at the tip of the obliquely cut-off stump with scissors to let the valve tip pass through. Yarn was cut to disconnect the anvil from a tube and the anvil head was retained in the esophagus. The end-Surgitie was inserted at the right subcostal margin, and after the looped-shaped thread was wrapped around the esophageal stump opening, assisting Maryland forceps inserted at the left subcostal and left abdomen were used to grasp the left and right esophageal stump. The surgeon inserted anvil grasping forceps into the right abdomen, and after grasping the esophagus with the forceps, tightened the end Surgitie, thereby completing the purse-string suture on the esophageal stump. The main unit of the automated stapler was inserted from the cut-off stump of the lifted jejunum, and a trocar was made to pass through. To prevent dropout of the small intestines from the automated stapler, the automated stapler and the lifted jejunum were fastened with silk thread, the abdomen was again inflated, and the lifted jejunum was led into the abdominal cavity. When it was confirmed that the automated stapler and center rod

  2. Dual-port distal gastrectomy for the early gastric cancer.

    Science.gov (United States)

    Kashiwagi, Hiroyuki; Kumagai, Kenta; Monma, Eiji; Nozue, Mutsumi

    2015-06-01

    Although recent trends in laparoscopic procedures have been toward minimizing the number of incisions, four or five ports are normally required to complete laparoscopic gastrectomy because of the complexity of this procedure. Multi-channel ports, such as the SILS port (Covidien, JAPAN), are now available and are crucial for performing single-incision laparoscopic surgery (SILS) or reduced port surgery (RPS). We carried out reduced port distal gastrectomy (RPDG) using a dual-port method with a SILS port. Ten patients who were diagnosed as early stage gastric cancer were offered the RPDG. Mean age and body mass index (BMI) were 68.1 and 21.4, respectively. No distant metastasis or regional lymph node swelling was seen in any case. A 5-mm flexible scope (Olympus, JAPAN) and SILS port were used and a nylon ligature with a straight needle, instead of a surgical instrument, was available to raise the gastric wall. The average operative time was 266.9 ± 38.3 min and blood loss was 37.8 ± 56.8 ml. Patients recovered well and experienced no complications after surgery. All patients could tolerate soft meals on the first day after surgery and the average hospital stay was 8.1 days. Past conventional LAG cases were evaluated to compare the short-term outcome and no difference was seen in the mean operative time or operative blood loss. The length of hospital stay after surgery was shorter for the RPDG group than the conventional operation group (p < 0.0001). Interestingly, the trend of serum CRP elevation after surgery was lower in the RPDG group than the conventional LAG group (p = 0.053). Although the benefits of RPS have not been established, this type of surgery may be expected to have some advantages. Cosmetic benefits and shorter hospital stays are clear advantages. Less invasiveness can be expected according to the trend of serum CRP elevation after RPDG.

  3. Improved design and durability of aluminum die casting horizontal shot sleeves

    Science.gov (United States)

    Birceanu, Sebastian

    The design and performance of shot sleeves is critical in meeting the engineering requirements of aluminum die cast parts. Improvement in shot sleeve materials have a major impact on dimensional stability, reproducibility and quality of the product. This investigation was undertaken in order to improve the life of aluminum die casting horizontal shot sleeves. Preliminary pin tests were run to evaluate the soldering, wash-out and thermal fatigue behavior of commercially available materials and coatings. An experimental rig was designed and constructed for shot sleeve configuration evaluation. Fabrication and testing of experimental shot sleeves was based upon preliminary results and manufacturing costs. Three shot sleeve designs and materials were compared to a reference nitrided H13 sleeve. Nitrided H13 is the preferred material for aluminum die casting shot sleeves because of wear resistance, strength and relative good soldering and wash-out resistance. The study was directed towards damage evaluation on the area under the pouring hole. This area is the most susceptible to damage because of high temperatures and impingement of molten aluminum. The results of this study showed that tungsten and molybdenum had the least amount of soldering and wash-out damage, and the best thermal fatigue resistance. Low solubility in molten aluminum and stability of intermetallic layers are main factors that determine the soldering and wash-out behavior. Thermal conductivity and thermal expansion coefficient directly influence thermal fatigue behavior. TiAlN nanolayered coating was chosen as the material with the best damage resistance among several commercial PVD coatings, because of relatively large thickness and simple deposition conditions. The results show that molybdenum thermal sprayed coating provided the best protection against damage under the pouring hole. Improved bonding is however required for life extension of the coating. TiAlN PVD coating applied on H13 nitrided

  4. Pancreatic enzyme supplementation after gastrectomy for gastric cancer: a randomized controlled trial.

    Science.gov (United States)

    Catarci, Marco; Berlanda, Manuele; Grassi, Giovanni Battista; Masedu, Francesco; Guadagni, Stefano

    2018-05-01

    Gastrectomy for gastric cancer is a significant cause of secondary exocrine pancreatic insufficiency. Pancreatic enzyme replacement therapy may influence nutritional status and quality of life after gastrectomy, but the pertinent clinical research to date remains controversial. A randomized controlled trial to test this hypothesis was carried out. After gastrectomy, 43 patients with gastric cancer were randomly assigned to a normal diet (Normal-d; n = 21) or to a pancreatic enzyme supplementation diet (PES-d; n = 22) and were followed up during a 12-month period, assessing nutritional status and quality of life through body mass index (BMI), instant nutritional assessment (INA) class status, serum pre-albumin (SPA) values, and GastroiIntestinal Quality of Life Index (GIQLI). BMI was not significantly influenced by the type of diet; INA class status was significantly improved in the PES-d arm, particularly during the first 3 months after gastrectomy; SPA levels increased in both arms at 6 months after gastrectomy, reaching significantly higher values in the PES-d arm at 12 months. GIQLI was not significantly influenced by the type of diet throughout the follow-up period; however, this index significantly improved in the PES-d arm between the first and third month after gastrectomy. PES-d improves nutritional status and quality of life after gastrectomy for gastric cancer, particularly within 3 months from the operation. A larger, multicenter trial is necessary to address the potential influence of several confounding variables such as disease stage and adjuvant treatments.

  5. Total Gastrectomy for Hereditary Diffuse Gastric Cancer at a Single Center: Postsurgical Outcomes in 41 Patients.

    Science.gov (United States)

    Strong, Vivian E; Gholami, Sepideh; Shah, Manish A; Tang, Laura H; Janjigian, Yelena Y; Schattner, Mark; Selby, Luke V; Yoon, Sam S; Salo-Mullen, Erin; Stadler, Zsofia K; Kelsen, David; Brennan, Murray F; Coit, Daniel G

    2017-12-01

    The aim of this study was to describe postoperative outcomes of total gastrectomy at our institution for patients with hereditary diffuse gastric cancer (HDGC). HDGC, which is mainly caused by germline mutations in the E-cadherin gene (CDH1), renders a lifetime risk of gastric cancer of up to 70%, prompting a recommendation for prophylactic total gastrectomy. A prospective gastric cancer database identified 41 patients with CDH1 mutation who underwent total gastrectomy during 2005 to 2015. Perioperative, histopathologic, and long-term data were collected. Of the 41 patients undergoing total gastrectomy, median age was 47 years (range 20 to 71). There were 14 men and 27 women, with 25 open operations and 16 minimally invasive operations. Median length of stay was 7 days (range 4 to 50). In total, 11 patients (27%) experienced a complication requiring intervention, and there was 1 peri-operative mortality (2.5%). Thirty-five patients (85%) demonstrated 1 or more foci of intramucosal signet ring cell gastric cancer in the examined specimen. At 16 months median follow-up, the median weight loss was 4.7 kg (15% of preoperative weight). By 6 to 12 months postoperatively, weight patterns stabilized. Overall outcome was reported to be "as expected" by 40% of patients and "better than expected" by 45%. Patient-reported outcomes were similar to those of other patients undergoing total gastrectomy. Total gastrectomy should be considered for all CDH1 mutation carriers because of the high risk of invasive diffuse-type gastric cancer and lack of reliable surveillance options. Although most patients have durable weight loss after total gastrectomy, weights stabilize at about 6 to 12 months postoperatively, and patients report outcomes as being good to better than their preoperative expectations. No patients have developed gastric cancer recurrence after resections.

  6. 3D finite element modeling of in-service sleeve repair welding of gas pipelines

    International Nuclear Information System (INIS)

    Alian, Ahmed R.; Shazly, Mostafa; Megahed, Mohammad M.

    2016-01-01

    The present work investigates the influence of welding sequence and scheme on residual stresses induced during in-service sleeve repair welding of gas pipelines. For this purpose, a 3D thermo-mechanical FE analysis is conducted on an 8″-Schedule-20, API 5L-X65 steel pipe. Two welding sequences for the sleeve-pipe circumferential fillet welds are compared in the present study: sequential welding in which one side of the sleeve is welded first and then the other side is welded by the same welder, and simultaneous welding in which both sides of the sleeve are welded concurrently by two welders. Within the simultaneous welding sequence, four different welding schemes, designed to investigate the influence of the number of welders and welding directions on residual stresses, are investigated. The results show that the sequential welding sequence induces less residual stresses and distortions. Within the simultaneous welding sequence, the back-step welding scheme is found to induce the least average residual stresses as compared to other welding schemes. - Highlights: • We model in-service sleeve repair welding using 3D FE. • Model was validated through comparison with existing experimental results. • The study presents results on the effect of both welding sequence and welding scheme on the resulting residual stresses. • Sequential welding sequence generates lower residual stresses than simultaneous welding sequence. • Back-step welding scheme generates the lowest average residual stresses along the pipe circumference.

  7. Crimped braided sleeves for soft, actuating arm in robotic abdominal surgery.

    Science.gov (United States)

    Elsayed, Yahya; Lekakou, Constantina; Ranzani, Tommaso; Cianchetti, Matteo; Morino, Mario; Arezzo, Alberto; Menciassi, Arianna; Geng, Tao; Saaj, Chakravarthini M

    2015-01-01

    This paper investigates different types of crimped, braided sleeve used for a soft arm for robotic abdominal surgery, with the sleeve required to contain balloon expansion in the pneumatically actuating arm while it follows the required bending, elongation and diameter reduction of the arm. Three types of crimped, braided sleeves from PET (BraidPET) or nylon (BraidGreyNylon and BraidNylon, with different monofilament diameters) were fabricated and tested including geometrical and microstructural characterisation of the crimp and braid, mechanical tests and medical scratching tests for organ damage of domestic pigs. BraidPET caused some organ damage, sliding under normal force of 2-5 N; this was attributed to the high roughness of the braid pattern, the higher friction coefficient of polyethylene terephthalate (PET) compared to nylon, and the high frequency of the crimp peaks for this sleeve. No organ damage was observed for the BraidNylon, attributed to both the lower roughness of the braid pattern and the low friction coefficient of nylon. BraidNylon also required the lowest tensile force during its elongation to similar maximum strain as that of BraidPET, translating to low power requirements. BraidNylon is recommended for the crimped sleeve of the arm designed for robotic abdominal surgery.

  8. The impact of old age on surgical outcomes of totally laparoscopic gastrectomy for gastric cancer.

    Science.gov (United States)

    Kim, Min Gyu; Kim, Hee Sung; Kim, Byung Sik; Kwon, Sung Joon

    2013-11-01

    Old age is regarded as the risk factor of major abdominal surgery due to the lack of functional reserve and the increased presence of comorbidities. This study aimed to evaluate the impact of old age on the surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. This study enrolled 389 gastric cancer patients who underwent totally laparoscopic gastrectomy at Hanyang University Guri Hospital and ASAN Medical Center. The patients were classified into two groups according to age as those older than 70 years and those younger than 70 years. Early surgical outcomes such as operation time, postoperative complications, time to first flatus, days until soft diet began, and hospital stay were evaluated. No patient was converted to open surgery. The two groups differed significantly in terms of overall postoperative complication rate, time to first flatus, days until soft diet began, and hospital stay. The patients who underwent Roux-en-Y gastrojejunostomy differed in incidence of postoperative ileus but not in severe postoperative complication rate. The results of this study demonstrated that old age can have an effect on the surgical outcomes of totally laparoscopic gastrectomy. This study especially showed that elderly patients are affected by the return of bowel movement after totally laparoscopic gastrectomy. On the other hand, however, it is presumed that old age has not had a serious impact on surgical outcomes in totally laparoscopic gastrectomy because no difference in the severe postoperative complication rate was observed.

  9. [Application of pylorus-vagus-preserving gastrectomy in early gastric cancer in middle third of stomach].

    Science.gov (United States)

    Hu, Junfeng; Shao, Qinshu; Sun, Yuanshui; Xu, Xiaodong; Xu, Ji

    2015-04-14

    To evaluate the long-term outcomes of pylorus-vagus-preserving partial gastrectomy for early gastric cancer in middle third of stomach. Between January 2004 and June 2009, 46 patients with early gastric cancer in middle third of stomach underwent pylorus-vagus-preserving partial gastrectomy (PPG) while another 85 patients had conventional distal gastrectomy (DG). Clinicopathologic data and follow-up results of two groups were analyzed retrospectively, including the results of subjective nutritional assessments, laboratory blood biochemical data, endoscopic findings of remnant stomach and total 5-year survival rates. Postprandial dumping syndrome occurred in 7 patients (8.2%) in DG group while no syndrome occurred in PPG group. The incidence of gallbladder stones at 18 months after operation in DG group was higher than that in PPG group. Significant difference existed between two groups (Pgastric remnant was frequently observed in PPG (31.1%) than in DG (10.8%, Pgastric cancer in middle third of stomach, pylorus-vagus-preserving partial gastrectomy is effective in maintaining postoperative function. And it has the same postoperative survival rate as conventional distal gastrectomy.

  10. [Laparoscopic Proximal Gastrectomy as a Surgical Treatment for Upper Third Early Gastric Cancer].

    Science.gov (United States)

    Park, Do Joong; Park, Young Suk; Ahn, Sang Hoon; Kim, Hyung Ho

    2017-09-25

    Recently, the incidence of upper third gastric cancer has increased, and with it the number of endoscopic submucosal dissection (ESD) procedures performed has been increasing. However, if ESD is not indicated or non-curable, surgical treatment may be necessary. In the case of lower third gastric cancer, it is possible to preserve the upper part of the stomach; however, in the case of upper third gastric cancer, total gastrectomy is still the standard treatment option, regardless of the stage. This is due to the complications associated with upper third gastric cancer, such as gastroesophageal reflux after proximal gastrectomy rather than oncologic problems. Recently, the introduction of the double tract reconstruction method after proximal gastrectomy has become one of the surgical treatment methods for upper third early gastric cancer. However, since there has not been a prospective comparative study evaluating its efficacy, the ongoing multicenter prospective randomized controlled trial (KLASS-05) comparing laparoscopic proximal gastrectomy with double tract reconstruction and laparoscopic total gastrectomy is expected to be important for determining the future of treatment of upper third early gastric cancer.

  11. Nutritional assessment methods as predictors of postoperative mortality in gastric cancer patients submitted to gastrectomy

    Directory of Open Access Journals (Sweden)

    Aline Kirjner Poziomyck

    Full Text Available ABSTRACT Objectives: to determine the nutritional evaluation method that best predicts mortality in 90 days of patients submitted to gastrectomy for gastric cancer. Methods: we conducted a prospective study with 44 patients with gastric cancer, stages II to IIIa, of whom nine were submitted to partial gastrectomy, 34 to total gastrectomy, and one to esophago-gastrectomy. All patients were nutritionally evaluated through the same protocol, up to 72h after hospital admission. The parameters used were Patient-Generated Subjective Global Assessment (PGSGA, classical anthropometry, current weight and height, percentage of weight loss (%WL and body mass index (BMI. We also measured the thickness of the thumb adductor muscle (TAM in both hands, dominant hand (TAMD and non-dominant hand (TAMND, as well as the calculated the prognostic nutritional index (PNI. The laboratory profile included serum levels of albumin, erythrocytes, hemoglobin, hematocrit, leukocytes, and total lymphocytes count (TLC. Results: of the 44 patients studied, 29 (66% were malnourished by the subjective method, 15 being grade A, 18 grade B and 11 grade C. Cases with PGSGA grade B and TAMD 10.2±2.9 mm were significantly associated with higher mortality. The ROC curves (95% confidence interval of both PGSGA and TAMD thickness reliably predicted mortality at 30 and 90 days. No laboratory method allowed predicting mortality at 90 days. Conclusion: PGSGA and the TAMD thickness can be used as preoperative parameters for risk of death in patients undergoing gastrectomy for gastric cancer.

  12. Robotic assisted gastrectomy compared with open resection: a case-matched study.

    Science.gov (United States)

    Caruso, Riccardo; Vicente, Emilio; Quijano, Yolanda; Ielpo, Benedetto; Duran, Hipolito; Diaz, Eduardo; Fabra, Isabel; Ferri, Valentina

    2018-05-04

    In recent years, increasingly sophisticated tools have allowed for more complex robotic surgery. Robotic gastrectomy, however, is adopted in only a few selected centers. The goals of this study were to examine the adoption of robotic gastrectomy and to compare outcomes between open and robotic gastric resections. This is a case-matched analysis of patients who underwent robotic and open gastric resection performed at Sanchinarro University Hospital, Madrid from November 2011 to February 2017. Patient data were obtained retrospectively. Clinicopathologic characteristics and perioperative and postoperative outcomes were recorded and analyzed. Two groups of demographically similar patients were analyzed: the robotic group (n = 20) and the open surgery group (n = 19). The patient characteristics of the two groups have been compared. Robotic resection resulted in less blood loss, shorter postoperative hospital stay, and a longer operating time. The two groups had similar complication rates. Pathological data were similar for both procedures. Robotic gastrectomy for locally advanced gastric carcinoma is safe, and long-term outcomes are comparable to those patients who underwent open resection. Robotic gastrectomy resulted in a shorter hospital stay, less blood loss and morbidity comparable with the outcomes of open gastrectomy.

  13. Preoperative determination of appropriate cutting line for proximal gastrectomy to avoid postoperative jejunal ulcer.

    Science.gov (United States)

    Takahashi, Naoto; Kashimura, Hirotaka; Nimura, Hiroshi; Watanabe, Atsushi; Yano, Kentaro; Aoki, Hiroaki; Koyama, Tomoki; Sasaki, Toshiyuki; Shida, Atsuo; Mitsumori, Norio; Aoki, Teruaki; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

    2012-01-01

    Although proximal gastrectomy has become a procedure of choice for patients' early cancer in the upper third of stomach, no clinical guide for optimal gastric resection in order to avoid postoperative jejunal ulcer is available. The aim of this study was to investigate whether determining the distribution of parietal and chief cells of the stomach using Congo red test is clinically relevant. The F-line was defined as a boundary line between fundic and intermediate area of the stomach according to the pathological findings in 29 patients who underwent total gastrectomy for early gastric cancer, whereas the f-line was regarded as a boundary line between intermediate and pyloric area. In the additional 6 patients undergoing vagus-preserving proximal gastrectomy with jejunal pouch interposition, endoscopic Congo red test was preoperatively performed to determine the F-f-line. The distances from the pyloric ring to f-line on the lesser and greater curvatures were variable. Long-term outcomes of proximal gastrectomy guided by preoperative endoscopic Congo red test were favorable. It is suggested that preoperative endoscopic Congo red test is useful to determine the appropriate cutting line in order to avoid postoperative jejunal ulcer after proximal gastrectomy.

  14. Status and Prospects of Robotic Gastrectomy for Gastric Cancer: Our Experience and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Sejin Lee

    2017-01-01

    Full Text Available Since the first report of robotic gastrectomy, experienced laparoscopic surgeons have used surgical robots to treat gastric cancer and resolve problems associated with laparoscopic gastrectomy. However, compared with laparoscopic gastrectomy, the superiority of robotic procedures has not been clearly proven. There are several advantages to using robotic surgery for gastric cancer, such as reduced estimated blood loss during the operation, a shorter learning curve, and a larger number of examined lymph nodes than conventional laparoscopic gastrectomy. The increased operation time observed with a robotic system is decreasing because surgeons have accumulated experience using this procedure. While there is limited evidence, long-term oncologic outcomes appear to be similar between robotic and laparoscopic gastrectomy. Robotic procedures have a significantly greater financial cost than laparoscopic gastrectomy, which is a major drawback. Recent clinical studies tried to demonstrate that the benefits of robotic surgery outweighed the cost, but the overall results were disappointing. Ongoing studies are investigating the benefits of robotic gastrectomy in more complicated and challenging cases. Well-designed randomized control trials with large sample sizes are needed to investigate the benefits of robotic gastrectomy compared with laparoscopic surgery.

  15. Current status in remnant gastric cancer after distal gastrectomy

    Science.gov (United States)

    Ohira, Masaichi; Toyokawa, Takahiro; Sakurai, Katsunobu; Kubo, Naoshi; Tanaka, Hiroaki; Muguruma, Kazuya; Yashiro, Masakazu; Onoda, Naoyoshi; Hirakawa, Kosei

    2016-01-01

    Remnant gastric cancer (RGC) and gastric stump cancer after distal gastrectomy (DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori (H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis. PMID:26937131

  16. Design improvement for partial penetration welds of Pressurizer heater sleeves to head junctures

    International Nuclear Information System (INIS)

    Kim, Jin-Seon; Lee, Kyoung-Jin; Park, Tae-Jung; Kim, Moo-Yong

    2007-01-01

    ASME Code, Section III allows partial penetration welds for openings for instrumentation on which there are substantially no piping reactions and requires to have interference fit or limited diametral clearance between nozzles and vessel penetrations for the partial penetration welds. Pressurizer heater sleeves are nonaxisymmetrically attached on the hill-side of bottom head by partial penetration welds. The excessive stresses in the partial penetration weld regions of the heater sleeves are induced by pressure and thermal transient loads and also by the deformation due to manual welding process. The purpose of this study is 1) to improve design for the partial penetration welds between heater sleeves to head junctures, 2) to demonstrate the structural integrity according to the requirements of ASME Code, Section III and 3) to improve welding procedure considering the proposed design

  17. Wearing long sleeves while prepping a patient in the operating room decreases airborne contaminants.

    Science.gov (United States)

    Markel, Troy A; Gormley, Thomas; Greeley, Damon; Ostojic, John; Wagner, Jennifer

    2018-04-01

    The use of long sleeves by nonscrubbed personnel in the operating room has been called into question. We hypothesized that wearing long sleeves and gloves, compared with having bare arms without gloves, while applying the skin preparation solution would decrease particulate and microbial contamination. A mock patient skin prep was performed in 3 different operating rooms. A long-sleeved gown and gloves, or bare arms, were used to perform the procedure. Particle counters were used to assess airborne particulate contamination, and active and passive microbial assessment was achieved through air samplers and settle plate analysis. Data were compared with Student's t-test or Mann-Whitney U, and P airborne contamination while the skin prep is applied, which may lead to decreased surgical site infections. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  18. Three cases of laparoscopic total gastrectomy with intracorporeal esophagojejunostomy for gastric cancer in remnant stomach.

    Science.gov (United States)

    Pan, Yu; Mou, Yi-Ping; Chen, Ke; Xu, Xiao-Wu; Cai, Jia-Qin; Wu, Di; Zhou, Yu-Cheng

    2014-11-13

    Gastric cancer in remnant stomach is a rare tumor but with poor prognosis. Compared with conventional open surgery, laparoscopic gastrectomy has potential benefits for these patients due to advantages resulting from its minimally invasive approach. Herein, we report on three patients with gastric cancer in remnant stomach who underwent laparoscopic total gastrectomy with intracorporeal esophagojejunostomy successfully. The operative time was 280, 250 and 225 minutes, the estimated blood loss was 100, 80 and 50 ml and the length of postoperative hospital stay was seven, eight and nine days respectively. Our experience has suggested that laparoscopic total gastrectomy with intracorporeal esophagojejunostomy can be a safe, feasible and promising option for patients with gastric cancer in remnant stomach.

  19. EVALUATION OF N-RATIO IN SELECTING PATIENTS FOR ADJUVANT CHEMORADIOTHERAPY AFTER D2-GASTRECTOMY

    Directory of Open Access Journals (Sweden)

    Wilson Luiz da COSTA JUNIOR

    2013-12-01

    Full Text Available Context Whether adjuvant chemoradiotherapy may contribute to improve survival outcomes after D2-gastrectomy remains controvertial. Objective To explore the clinical utility of N-Ratio in selecting gastric cancer patients for adjuvant chemoradiotherapy after D2-gastrectomy. Methods A retrospective cohort study was carried out on gastric cancer patients who underwent D2-gastrectomy alone or D2-gastrectomy plus adjuvant chemoradiotherapy (INT-0116 protocol at the Hospital A. C. Camargo from September 1998 to December 2008. Statistical analysis were performed using multiple conventional methods, such as c-statistic, adjusted Cox's regression and stratified survival analysis. Results Our analysis involved 128 patients. According to c-statistic, the N-Ratio (i.e., as a continuous variable presented “area under ROC curve” (AUC of 0.713, while the number of metastatic nodes presented AUC of 0.705. After categorization, the cut-offs provide by Marchet et al. displayed the highest discriminating power – AUC value of 0.702. This N-Ratio categorization was confirmed as an independent predictor of survival using multivariate analyses. There also was a trend of better survival by adding of adjuvant chemoradiotherapy only for patients with milder degrees of lymphatic spread – 5-year survival of 23.1% vs 66.9%, respectively (HR = 0.426, 95% CI 0.150–1.202; P = 0.092. Conclusions This study confirms the N-Ratio as a tool to improve the lymph node metastasis staging in gastric cancer and suggests the cut-offs provided by Marchet et al. as the best way for its categorization after a D2-gastrectomy. In these settings, the N-Ratio appears a useful tool to select patients for adjuvant chemoradiotherapy, and the benefit of adding this type of adjuvancy to D2-gastrectomy is suggested to be limited to patients with milder degrees of lymphatic spread (i.e., NR2, 10%–25%.

  20. Changes in lipid indices and body composition one year after laparoscopic gastrectomy: a prospective study.

    Science.gov (United States)

    Lee, Soo Jin; Kim, Ji Young; Ha, Tae Kyung; Choi, Yun Young

    2018-05-11

    The purpose of this prospective study was to investigate changes in lipid indices associated with whole body composition during 1 year of follow-up after laparoscopic gastrectomy. Thirty-seven patients with benign and malignant gastric neoplasm who underwent laparoscopic gastrectomy were prospectively enrolled. None of the patients were treated with adjuvant chemotherapy. Lipid indices and body composition were measured preoperatively and at six and 12 months after laparoscopic gastrectomy. Lipid indices included total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). Body weight, fat and lean body mass (LBM) were measured by dual-energy X-ray absorptiometry and the change in fat and LBM in the trunk, arms and legs was compared. Body weight significantly decreased from 63.0 ± 11.1 kg preoperatively to 56.8 ± 10.6 kg 12 months after laparoscopic gastrectomy, with a mean of 7.1% (4.6 kg) weight loss. Fat and LBM loss contributed 68.4% (3.1 kg) and 30.1% (1.4 kg) of the total weight loss, respectively. In both the non-obese and obese groups, body weight, fat and LBM did not change significantly between 6 months and 12 months after gastrectomy. TC and LDL-C levels significantly decreased during the first six-month period and HDL-C significantly increased until 12 months after gastrectomy in the non-obese group. In the obese group, the degree of reduction in fat mass was significantly higher and the LBM/weight ratio significantly increased compared with the non-obese group. However, there was no significant change in lipid indices in the obese group. The TG level was significantly correlated with fat, especially with trunk fat. Gastrectomy resulted in improved lipid indices and a reduction in body weight, fat and LBM. The HDL-C significantly increased in the non-obese group for 1 year after gastrectomy and the reduction of TG level was positively correlated with fat

  1. A study by upper digestive tract scintigraphy of cases with recurrent pneumonia after gastrectomy

    International Nuclear Information System (INIS)

    Yokomura, Ichiro; Fukabori, Takashi; Mizobuchi, Kazuya; Yoneda, Mitsuru; Yagi, Yasuo; Nakamura, Mitsuo

    1997-01-01

    Five patients with recurrent pneumonia after gastrectomy were studied by upper digestive tract scintigraphy. Severe gastroesophageal reflux was noted in three of the five patients in the supine position. In the other two patients, the same kind of reflux was easily induced by changing position. Esophageal dysfunction was suspected in four patients. The frequency of pneumonia decreased after we instructed the patients how to avoid reflux. We therefore diagnosed it as the chronic aspiration pneumonia. We concluded that upper digestive tract scintigraphy is useful for evaluating gastroesophageal reflux and esophageal function in patients after gastrectomy. (author)

  2. A study by upper digestive tract scintigraphy of cases with recurrent pneumonia after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Yokomura, Ichiro; Fukabori, Takashi; Mizobuchi, Kazuya; Yoneda, Mitsuru; Yagi, Yasuo; Nakamura, Mitsuo [Shakaihoken Kobe Central Hospital (Japan)

    1997-03-01

    Five patients with recurrent pneumonia after gastrectomy were studied by upper digestive tract scintigraphy. Severe gastroesophageal reflux was noted in three of the five patients in the supine position. In the other two patients, the same kind of reflux was easily induced by changing position. Esophageal dysfunction was suspected in four patients. The frequency of pneumonia decreased after we instructed the patients how to avoid reflux. We therefore diagnosed it as the chronic aspiration pneumonia. We concluded that upper digestive tract scintigraphy is useful for evaluating gastroesophageal reflux and esophageal function in patients after gastrectomy. (author)

  3. Trends in gastrectomy and ADH1B and ALDH2 genotypes in Japanese alcoholic men and their gene-gastrectomy, gene-gene and gene-age interactions for risk of alcoholism.

    Science.gov (United States)

    Yokoyama, Akira; Yokoyama, Tetsuji; Matsui, Toshifumi; Mizukami, Takeshi; Kimura, Mitsuru; Matsushita, Sachio; Higuchi, Susumu; Maruyama, Katsuya

    2013-01-01

    The life-time drinking profiles of Japanese alcoholics have shown that gastrectomy increases susceptibility to alcoholism. We investigated the trends in gastrectomy and alcohol dehydrogenase-1B (ADH1B) and aldehyde dehydrogenase-2 (ALDH2) genotypes and their interactions in alcoholics. This survey was conducted on 4879 Japanese alcoholic men 40 years of age or older who underwent routine gastrointestinal endoscopic screening during the period 1996-2010. ADH1B/ALDH2 genotyping was performed in 3702 patients. A history of gastrectomy was found in 508 (10.4%) patients. The reason for the gastrectomy was peptic ulcer in 317 patients and gastric cancer in 187 patients. The frequency of gastrectomy had gradually decreased from 13.3% in 1996-2000 to 10.5% in 2001-2005 and to 7.8% in 2006-2010 (P alcoholism-susceptibility genotypes, ADH1B*1/*1 and ALDH2*1/*1, modestly but significantly tended not to occur in the same individual (P = 0.026). The frequency of ADH1B*1/*1 decreased with ascending age groups. The high frequency of history of gastrectomy suggested that gastrectomy is still a risk factor for alcoholism, although the percentage decreased during the period. The alcoholism-susceptibility genotype ADH1B*1/*1 was less frequent in the gastrectomy group, suggesting a competitive gene-gastrectomy interaction for alcoholism. A gene-gene interaction and gene-age interactions regarding the ADH1B genotype were observed.

  4. Effect of Yaw Angle and Ambient Wind on Fabric Penetration of a Simulated Sleeve

    Science.gov (United States)

    2015-08-20

    took a day of trial-and-error testing. Of concern is the effect of the fabric sleeve on the flowfield. It is possible that the introduction of the...stephanie.f.zopf.civ@mail.mil CLARKSON UNIVERSITY (1) Mechanical Engineering Department 8 Clarkson Ave., Potsdam , NY 13699 sdhaniyala

  5. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  6. The Single Needle Lockstitch Machine. [Constructing and Setting Sleeves.] Module 7.

    Science.gov (United States)

    South Carolina State Dept. of Education, Columbia. Office of Vocational Education.

    This module on constructing and setting sleeves, one in a series on the single needle lockstitch sewing machine for student self-study, contains two sections. Each section includes the following parts: an introduction, directions, an objective, learning activities, student information, student self-check, check-out activities, and an instructor's…

  7. Modified Sleeve Technique in Aortic Valve-Sparing Operation for Marfan Syndrome.

    Science.gov (United States)

    Wu, Yung-Szu; Hsieh, Shih-Rong; Wang, Chung-Chi; Tsai, Chung-Lin

    2018-03-22

    We devised a simple modification of the Florida Sleeve procedure to perform aortic valve-sparing surgery. This technique is simple, quick, effective, and safe. We used this technique in operations performed on two young patients with Marfan syndrome. The initial and short-term results were satisfactory.

  8. Rotor losses in laminated magnets and an anisotropic carbon fiber sleeve

    NARCIS (Netherlands)

    Van der Geest, M.; Wolmarans, J.J.; Polinder, H.; Ferreira, J.A.; Zeilstra, D.

    2012-01-01

    High speed fault tolerant permanent magnet machines have strong asynchronous airgap harmonics, making them susceptible to rotor eddy-current losses. These losses can be reduced by using novel high resistivity materials like plastic bonded magnets and carbon fiber reinforced retaining sleeves. This

  9. Numerical Simulation and Experimental Validation of an Integrated Sleeve-Wedge Anchorage for CFRP Rods

    DEFF Research Database (Denmark)

    Schmidt, Jacob Wittrup; Smith, Scott T.; Täljsten, Björn

    2011-01-01

    . Recently, an integrated sleeve-wedge anchorage has been successfully developed specifically for CFRP rods. This paper in turn presents a numerical simulation of the newly developed anchorage using ABAQUS. The three-dimensional finite element (FE) model, which considers material non-linearity, uses...

  10. Endoscopic sleeve gastroplasty (the Apollo method: a new approach to obesity management

    Directory of Open Access Journals (Sweden)

    Gontrand López-Nava-Breviere

    2016-04-01

    Full Text Available Background: Many obese patients cannot lose weight or reject conventional obesity management. Endoscopic sleeve gastroplasty (the Apollo method is a pioneering coadjuvant, interventionist technique for the integral management of obesity. Objectives: The goals of this study were to report safety and efficacy results obtained at 6 months in patients undergoing endoscopic sleeve gastroplasty. Material and methods: A prospective study was performed in 55 patients (13 males, 42 females who were subjected to the Apollo technique; mean age was 43.5 years (range 25-60 and mean BMI was 37.7 kg/m² (range 30-48. All received multidisciplinary follow-up for weight loss. Weight changes and presence of complications were assessed. Through the endoscope a triangular pattern suture is performed consisting of approximately 3-6 transmural (mucosa to serosa stitches, using a cinch device to bring them nearer and form a plication. Results: A total of 6-8 plications are used to provide a tubular or sleeve-shaped restriction to the gastric cavity. No major complications developed and patients were discharged at 24 hours following the procedure. Endoscopic and radiographic follow-up at 6 months post-procedure showed a well preserved tubular form to the stomach. After 6 months patients had lost 18.9 kg and 55.3% of excess weight. Conclusions: Endoscopic sleeve gastroplasty, together with dietary and psycho-behavioral changes, is a safe, effective technique in the coadjuvant management of obese patients.

  11. Development of a high speed extrusion concept using a floating screw sleeve for solid-melt-separation

    Science.gov (United States)

    Karrenberg, Gregor; Wortberg, Johannes

    2015-05-01

    The High-Speed-S-Truder with floating screw sleeve is an alternative extrusion concept with solid-melt-separation. A fairly conventional 35 mm screw with a length of 21 D, which is accelerated by a 75 kW gearless, water cooled synchronous drive, conveys the resin into a 60 mm screw sleeve with a length of 10 D. Inside the sleeve the material is plasticizied and discharged into the outer screw channel of the sleeve through radial bores. Only the solid bed remains inside. The development of a melt pool - and thus a decrease of the plasticizing capacity - is avoided. The sleeve is rotated by drag forces only (approximately 10 - 15 % of the screw speed). Due to the low speed of the screw sleeve molten material is conveyed to a 4 D Dynamic Mixing Ring in a gentle manner. The DMRs floating ring and the screw sleeve are directly coupled. The granules in the screw channel are stopped by a barrier on the screw in front of the mixing device. So nearly no unmelted material can pass the system. For temperature management in the plastification and mixing zone a 3-zone heating/air-cooling system is used. Various kinds of experiments with the High-Speed S-Truder were conducted. Reachable throughputs with different types of material (LDPE, LLDPE, PP, PS) have been tested. Also three screw geometries, which are mainly varying in the channel depth, were compared. Experimental results and theoretical background will be described in this paper.

  12. Solo Intracorporeal Esophagojejunostomy Reconstruction Using a Laparoscopic Scope Holder in Single-Port Laparoscopic Total Gastrectomy for Early Gastric Cancer.

    Science.gov (United States)

    Ahn, Sang-Hoon; Son, Sang-Yong; Jung, Do Hyun; Park, Young Suk; Shin, Dong Joon; Park, Do Joong; Kim, Hyung-Ho

    2015-06-01

    Single-incision laparoscopic total gastrectomy for gastric cancer has recently been reported by Seoul National University Bundang Hospital. However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy. At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy. In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer.

  13. Changes of nutritional status after distal gastrectomy in patients with gastric cancer.

    Science.gov (United States)

    Katsube, Takao; Konnno, Soichi; Murayama, Minoru; Kuhara, Kotaro; Sagawa, Masano; Yoshimatsu, Kazuhiko; Shiozawa, Shunnichi; Shimakawa, Takeshi; Naritaka, Yoshihiko; Ogawa, Kenji

    2008-01-01

    In Japan, distal gastrectomy is the most common operation performed to treat gastric cancer. However, this procedure often leads to postoperative problems such as weight loss. We assessed the changes of nutritional status early after operation and the associations of the postoperative body weight (as a percentage of the preoperative weight) and background factors in patients who underwent distal gastrectomy. We measured the changes of nutritional indices (mean body weight, TSF, AMC and Alb) and nutrition intake on the day before operation (before operation), before postoperative resumption of oral intake (before oral intake), and on the fifth day of a soft rice porridge diet (after soft rice). Background factors included gender, age, preoperative BMI and preoperative exercise. Mean body weight, TSF, and AMC significantly decreased from before operation, to the day before oral intake and to the day after soft rice. The postoperative body weight was not associated with the gender, age, or preoperative BMI. The frequency of regular preoperative exercise was associated with the postoperative body weight. The total daily calorie intake was 1,664 kcal (before operation), 398 kcal (before oral intake), and 949 kcal (after soft rice). To conclude, nutritional status changes significantly after distal gastrectomy. Early nutrition intervention may be needed in patients who undergo distal gastrectomy for gastric cancer.

  14. Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

    Science.gov (United States)

    Song, Byeong Gu; Lee, Bong Eun; Jeon, Hye Kyung; Baek, Dong Hoon; Song, Geun Am

    2017-01-01

    Aims To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the remnant stomach (GEN-RS) after various types of partial gastrectomy. Methods This study included 29 patients (31 lesions) who underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively to assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events. Results The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous gastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors involving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The procedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range, 6–58 months), there was no recurrence in any case. Conclusions ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the complete resection rate decreases for lesions involving the suture lines. PMID:28592968

  15. Sleeving-back of horizontal wells to control downstream oil saturation and improve oil recovery

    Energy Technology Data Exchange (ETDEWEB)

    Greaves, M.; Saghr, A. M. [Bath Univ (United Kingdom)

    1998-12-31

    Air injection has become popular as an enhanced recovery technology, applicable over a wide variety of reservoir conditions including heavy, medium and light oils. One problem observed in light oil reservoirs is the tendency to desaturate the oil layer downstream of the moving front. This is particularly common in the case of thermal recovery processes. In this experiment designed to study ways to restrict the de-saturation of the oil layer, a modified horizontal producer well, incorporating a `sleeve-back` principal was used. The objective was to replicate the `toe-to-heel` displacement process occurring during heavy oil recovery, wherein downstream oil is essentially immobile due to its high viscosity. The `sleeve-back` of the well was achieved using a co-aligned, two-well assembly, so that the upstream section of the horizontal producer well was active, and continuously adjusted during propagation of the combustion front. The use of this continuous `sleeve-back` operation to control the level of de-saturation in the downstream section of a sand pack was successful as confirmed by the very high oil recovery achieved, equivalent to 93.5 per cent of oil in place. The level of CO{sub 2} production was also very high. The `sleeve-back` of the horizontal producer well made the light oil in-situ combustion more efficient compared to what would be expected in a fully-open well. The `sleeve-back` of the well also produced thermal contours in the sand pack that closely resembled those observed with heavy, highly viscous oil. By sealing-off the otherwise open well in the downstream part of the reservoir, the de-saturation of the oil layer was prevented. 9 refs., 4 tabs., 9 figs.

  16. Clinical practice guidelines for rest orthosis, knee sleeves, and unloading knee braces in knee osteoarthritis.

    Science.gov (United States)

    Beaudreuil, Johann; Bendaya, Samy; Faucher, Marc; Coudeyre, Emmanuel; Ribinik, Patricia; Revel, Michel; Rannou, François

    2009-12-01

    To develop clinical practice guidelines concerning the use of bracing--rest orthosis, knee sleeves and unloading knee braces--for knee osteoarthritis. The French Physical Medicine and Rehabilitation Society (SOFMER) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by multidisciplinary expert panel, was used. Few high-level studies of bracing for knee osteoarthritis were found. No evidence exists for the effectiveness of rest orthosis. Evidence for knee sleeves suggests that they decrease pain in knee osteoarthritis, and their use is associated with subjective improvement. These actions do not appear to depend on a local thermal effect. The effectiveness of knee sleeves for disability is not demonstrated for knee osteoarthritis. Short- and mid-term follow-up indicates that valgus knee bracing decreases pain and disability in medial knee osteoarthritis, appears to be more effective than knee sleeves, and improves quality of life, knee proprioception, quadriceps strength, and gait symmetry, and decreases compressive loads in the medial femoro-tibial compartment. However, results of response to valgus knee bracing remain inconsistent; discomfort and side effects can result. Thrombophlebitis of the lower limbs has been reported with the braces. Braces, whatever kind, are infrequently prescribed in clinical practice for osteoarthritis of the lower limbs. Modest evidence exists for the effectiveness of bracing--rest orthosis, knee sleeves and unloading knee braces--for knee osteoarthritis, with only low level recommendations for its use. Braces are prescribed infrequently in French clinical practice for osteoarthritis of the knee. Randomized clinical trials concerning bracing in knee osteoarthritis are still necessary.

  17. Anticorrosive field joint coating qualification, heat shrinkable sleeve; Qualificacao de revestimento anticorrosivo para juntas de campo, mantas termocontrateis

    Energy Technology Data Exchange (ETDEWEB)

    Cabral, Glaucia B.; Koebsch, Andre; Castinheiras Junior, Wilson [PETROBRAS, Rio de Janeiro, RJ (Brazil)

    2005-07-01

    The main objective of this job is to present the quality requirements fixed by PETROBRAS for anticorrosive field joint coating for buried pipelines, industrially coated with PE-3L. It describes the used system - polyethylene based heat shrinkable sleeve - comparing with the existent on the pipeline. So, it exposes the suppliers' qualification stages, which include test carried out for the materials, for the sleeve set and for the coating after its application on the joint field. Finally, it shows that the experience, which has been gotten in the qualification, consolidated the quality control systematic that have been carry out during the sleeves acquisition and application at the pipeline construction. (author)

  18. Effects of total gastrectomy on plasma silicon and amino acid concentrations in men.

    Science.gov (United States)

    Tatara, Marcin R; Krupski, Witold; Szpetnar, Maria; Dąbrowski, Andrzej; Bury, Paweł; Szabelska, Anna; Charuta, Anna; Boguszewska-Czubara, Anna; Maciejewski, Ryszard; Wallner, Grzegorz

    2015-12-01

    The aim of the study was to determine one-year effects of total gastrectomy on plasma silicon and free amino acid concentrations in patients and evaluate changes of volumetric bone mineral density (vBMD) in lumbar spine. Eight patients were enrolled to the control (CTR) group. Six patients subjected to total gastrectomy (GX group) were included to the experimental group. vBMD in trabecular and cortical bone was measured in lumbar vertebrae at baseline (before surgery) and one year later using quantitative computed tomography. Plasma concentrations of silicon and free amino acids were determined at baseline and one year later using photometric method and ion-exchange chromatography. Body weights within CTR and GX groups were not different after one-year follow-up when compared to the baseline values (P > 0.05). An average annual decrease of vBMD in the trabecular bone in the gastrectomized patients reached 15.0% in lumbar spine and was significantly different in comparison to the percentage changes observed in CTR group (P = 0.02). One-year percentage change of vBMD in the cortical bone in L1 and L2 has shown significantly decreased values by 10.5 and 9.1% in the GX group when compared to the percentage change observed in the controls (P silicon was significantly lowered by 26.7% one year after the total gastrectomy when compared to the baseline value (P = 0.009). Total gastrectomy in patients has induced severe osteoporotic changes in lumbar spine within one-year period. The observed osteoporotic changes were associated with decreased plasma concentration of silicon indicating importance of exocrine and endocrine functions of stomach for silicon homeostasis maintenance. Gastrectomy-induced bone loss was not related to decreased amino acid concentration in plasma obtained from overnight fasted patients. © 2015 by the Society for Experimental Biology and Medicine.

  19. Acid Secretion and Its Relationship to Esophageal Reflux Symptom in Patients with Subtotal Gastrectomy.

    Science.gov (United States)

    Oh, Hyun Jin; Choi, Myung-Gyu; Park, Jae Myung; Song, Kyo Young; Yoo, Han Mo

    2018-03-01

    Esophageal reflux symptom has been reported as common in patients with subtotal gastrectomy. Management of postoperative esophageal reflux symptom is not satisfactory. The aim of this study is to investigate prevalence of esophageal reflux symptom after subtotal gastrectomy and assess factors affecting esophageal reflux symptom in subtotal gastrectomy patients. We prospectively enrolled 100 consecutive patients with subtotal gastrectomy who were regularly followed up by endoscopic examination. Acid secretory capacity was assessed by measuring messenger RNA (mRNA) expression of H + /K + -adenosine triphosphatase (ATPase) via real-time polymerase chain reaction (PCR) in biopsy specimens. In total, 47 % of patients had typical esophageal reflux symptom, where heartburn or regurgitation was experienced at least weekly. Age, sex, body mass index, and type of reconstruction did not differ between esophageal reflux and non-esophageal-reflux groups. The esophageal reflux group had longer duration from time of operation until study (median 5.0 versus 3.6 years; P = 0.017). Hill grade for gastroesophageal (GE) flap valve was higher in the esophageal reflux group than in the non-esophageal-reflux group (P = 0.027). H + /K + -ATPase mRNA expression was higher in the esophageal reflux group than in the non-esophageal-reflux group [3967.6 (± 7583.7) versus 896.2 (± 1456.0); P = 0.006]. Multivariate analysis revealed that postoperative duration, H + /K + -ATPase mRNA expression level, and GE flap valve disruption were significantly associated with esophageal reflux symptom development. Esophageal reflux symptom is common in patients after subtotal gastrectomy, possibly because of anti-reflux-barrier impairment and preservation of acid secretory capacity following surgery. Optimal acid suppression may be helpful in managing postoperative esophageal reflux symptom.

  20. Bariatric surgery in Singapore from 2005 to 2009

    Directory of Open Access Journals (Sweden)

    Rajat Goel

    2013-01-01

    Conclusion: There is a flux of newer procedures in Singapore. Adjustable gastric banding, which was the only available procedure being performed in 2004, was gradually being replaced by other procedures such as sleeve gastrectomy and Roux-en-Y gastric bypass in 2009.

  1. Experimental Qualification of the Sleeved Pin Multilink Attachment for Divertor PFC's

    International Nuclear Information System (INIS)

    Poutanen, J.; McCallum, A.; Turner, A.; Merola, M.

    2006-01-01

    The latest design for connecting the limited life ITER divertor plasma facing components (PFC's) to the reusable cassette body is the so called sleeved pin multilink attachment. The connection is made by expanding a 43 mm diameter hollow AlBr pin inside the fixation holes of components of the cassette body and PFC by a swaging process. The multilink is an easy, safe and fast assembly method, but the original dismantling method of drilling out the pin was found troublesome. Therefore, in the latest attachment design a thin sleeve is incorporated between the pin and the holes, which makes it possible to dismantle the joint by simply pulling out the pin and sleeve sequentially. Experimental qualification of the new sleeved design is now proceeding. The aim of the experimental qualification is to prove that the sleeved design meets the requirements of load carrying capability, clearance free connection, and easy and safe removal. Associated analytical studies were performed to develop and verify theoretical models and correlations for use in design. Results from the experimental qualification will provide reference information for developing tools for making and removing the connection. Theoretical finite element models in association with the results of earlier test campaigns with nonsleeved design were used to determine pin expansion parameters. The expansion parameters were verified with plate-pin tests measuring contact pressures produced by pin expansion. The plate-pin tests were also used to demonstrate the feasibility of pin removal and develop pin removal methodology. The mechanical capabilities of the connection design are being examined with test series of cyclic tensile loading plus articulation-induced loading of a single connection mock-up. Remaking properties of the attachment are being studied with multiple swaging and removing of the pin into the fixation holes. Finally the dismantling of the connection will be examined with full length pin extraction

  2. Control of Cocoa Pod Borer and Phytophthora Pod Rot Using Degradable Plastic Pod Sleeves and a Nematode, Steinernema Carpocapsae

    OpenAIRE

    Rosmana, Ade; Shepard, Merle; Hebbar, Prakash; Mustari, Anita

    2010-01-01

    Cocoa pod borer (CPB; Conopomorpha cramerella) and Phytophthora pod rot (PPR; Phytophthora palmivora) are serious pest and disease on cocoa plantations in Indonesia. Both pest and disease have been controlled with limited success using cultural practices such as pruning, frequent harvesting, sanitation, plastic sleeving, and chemical pesticides. An experiment was conducted on cocoa plantings in Pinrang Regency, South Sulawesi during the wet season of 2008/09 to test the effect of pod sleeving...

  3. Serial comparisons of quality of life after distal subtotal or total gastrectomy: what are the rational approaches for quality of life management?

    Science.gov (United States)

    Park, Sujin; Chung, Ho Young; Lee, Seung Soo; Kwon, Ohkyoung; Yu, Wansik

    2014-03-01

    The aims of this study were to make serial comparisons of the quality of life (QoL) between patients who underwent total gastrectomy and those who underwent distal subtotal gastrectomy for gastric cancer and to identify the affected scales with consistency. QoL data of 275 patients who were admitted for surgery between September 2008 and June 2011 and who underwent subtotal gastrectomy or total gastrectomy were obtained preoperatively and postoperatively at 3, 6, 9, 12, 18, and 24 months. The Korean versions of the European Organization for Research and Treatment (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and the gastric cancer specific module, the EORTC QLQ-STO22, were used to assess QoL. QoL, as assessed by the global health status/QoL and physical functioning, revealed a brief divergence with worse QoL in the total gastrectomy group 3 months postoperatively, followed by rapid convergence. QoL related to restrictive symptoms (nausea/vomiting, dysphagia, reflux, and eating restrictions) and dry mouth was consistently worse in the total gastrectomy group during the first 2 postoperative years. The general QoL of patients after gastrectomy is highly congruent with subjective physical functioning, and the differences between patients who undergo total gastrectomy and subtotal gastrectomy are no longer valid several months after surgery. In order to further reduce the differences in QoL between patients who underwent total gastrectomy and subtotal gastrectomy, definitive preoperative informing, followed by postoperative symptomatic management, of restrictive symptoms in total gastrectomy patients is the most rational approach.

  4. Numerical and experimental investigation of flow and heat transfer in a T-junction with thermal sleeve

    International Nuclear Information System (INIS)

    Wu Hailing; Chen Tingkuan; Wang Haijun; Luo Yushan; Mao Qing; Zhang Yixiong

    2002-01-01

    Numerical simulations were performed with the commercial computational fluid dynamics (CFD) package FLUENT 5.3 to investigate the thermal-hydraulic phenomena of thermal shock, which is caused by non-isothermal turbulent jet into crossflow in a T-junction with thermal sleeve in the pressurized water reactor (PWR) cooling systems. In allusion to the thermal sleeve configuration with vent holes and lower collar, two typical cases with jet-to-mainstream velocity ratios of 0.05 and 0.5 were computed. Experimental studies were carried out to determine the heat transfer characteristics for the main pipe and the annulus between the nozzle and the thermal sleeve. The calculations well matches the experimental data. The results indicated that the protective action of the thermal sleeve against thermal shock loading is dependent on both the sleeve geometry and the velocity ratio, obtaining improvement with appropriate lower velocity ratios. In addition, optimal flow rates and partial sizes of the thermal sleeve were discussed to reduce the thermal shock

  5. Management of a case of left tracheal sleeve pneumonectomy under cardiopulmonary bypass: Anesthesia perspectives

    Directory of Open Access Journals (Sweden)

    Aman Jyoti

    2014-01-01

    Full Text Available The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB. Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.

  6. Irradiation-induced dimensional changes of fuel compacts and graphite sleeves of OGL-1 fuel assemblies

    International Nuclear Information System (INIS)

    Hayashi, Kimio; Minato, Kazuo; Kobayashi, Fumiaki; Tobita, Tsutomu; Kikuchi, Teruo; Kurobane, Shiro; Adachi, Mamoru; Fukuda, Kousaku

    1988-06-01

    Experimental data are summarized on irradiation-induced dimensional changes of fuel compacts and graphite sleeves of the first to ninth OGL-1 fuel assemblies. The range of fast-neutron fluence is up to 4 x 10 24 n/m 2 (E > 0.18 MeV); and that of irradiation temperature is 900 - 1400 deg C for fuel compacts and 800 - 1050 deg C for graphite sleeves. The dimensional change of the fuel compacts was shrinkage under these test conditions, and the shrinkage fraction increased almost linearly with fast-neutron fluence. The shrinkage fraction of the fuel compacts was larger by 20 % in the axial direction than in the radial direction. Influence of the irradiation temperature on the dimensional-change behavior of the fuel compacts was not observed clearly; presumably the influence was hidden by scatter of the data because of low level of the fast-neutron fluence and the resultant small dimensional changes. (author)

  7. DURABILITY-RELATED CHARACTERISTICS OF DOUBLE-LAYER STRUCTURES OF PIPELINES CONNECTED TO POLYMERIC SLEEVES

    Directory of Open Access Journals (Sweden)

    Orlov Vladimir Alexandrovich

    2012-10-01

    The ultimate objective of the software programme is to assess the applicability of the trenchless repair method involving a polymeric sleeve in each specific case by taking account of the environment and the condition of the pipeline. The software is also capable of developing the requirements to be fulfilled by subcontractors in order to assure the appropriate quality of any repair work performed and the reliability of any pipeline sections repaired.

  8. Testing of a new prototype surgical stapler that automates the rollover sleeve technique for venous anastomoses

    OpenAIRE

    PATRICIA B CARROLL; WERVISTON DEFARIA; CARLOS GANDIA; MARIANA BERHO; EVANGELOS MISIAKOS; ANDREAS G TZAKIS

    2006-01-01

    The creation of successful vascular anastomoses is of primary importance in many surgical fields. Numerous attempts to automate this process have been made. These techniques have slowly gained acceptance, but their use is still limited. This report details feasibility testing of a new prototype stapler that automates the rollover sleeve technique for venous vascular anastomoses. Male and female mongrel dogs (n=7) (25-32 kg) were used. A segment of the right (n=5) or left (n=2) iliac vein was ...

  9. Early and medium term results of the sleeve valve-sparing procedure for aortic root ectasia.

    Science.gov (United States)

    Gamba, Amando; Tasca, Giordano; Giannico, Floriana; Lobiati, Elisabetta; Skouse, Douglas; Galanti, Andrea; Martino, Antonello Stefano; Triggiani, Michele

    2015-04-01

    The aim of this retrospective study was to evaluate our experience of using a simplified aortic valve sleeve procedure to treat aortic root ectasia and aneurysms with or without aortic regurgitation. In experienced hands, 2 aortic valve-sparing procedures, ie, Yacoub and David, have yielded excellent long-term results in the treatment of aortic root aneurysms, with or without aortic regurgitation. However, these techniques are demanding and not widely used. Recently, a new and simplified valve-sparing technique, named "sleeve procedure," has been proposed, and has yielded encouraging early results. Ninety consecutive patients with aortic root aneurysms underwent sleeve procedures from October 2006 to October 2012. Follow-up data (clinical 100% complete and echocardiographic 93% complete) were acquired from our outpatient clinic or from the referring cardiologist. The mean age of the patients was 61.5 ± 12.5 years, 79% were male, 16 (18%) had a bicuspid valve, 3 had Marfan syndrome, and 2 had aortic dissection. Over a mean clinical follow-up of 34 ± 19 months, 2 patients died from noncardiac causes and 1 was reoperated on for the recurrence of aortic regurgitation. On follow-up echocardiography after a mean of 18 ± 9 months, aortic regurgitation was absent/negligible, mild or moderate in 62%, 37%, and 1% of patients, respectively, and the diameters of the annulus, Valsalva sinuses, and sinotubular junction were 27.3 + 2.2, 37.0 + 3.4, and 30.6 + 3.1 mm, respectively. Our encouraging early and medium term results suggest that the sleeve procedure is a safe and effective aortic valve-sparing technique for the treatment of aortic root ectasia and aneurysm. However, longer follow-up is needed in order to draw definitive conclusions. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Heat Generation and Efficiency of a New Modified Phaco Tip and Sleeve.

    Directory of Open Access Journals (Sweden)

    Aeri Yoo

    Full Text Available To compare a modified phacoemulsification tip with the established micro tip, in terms of temperature at the corneal wound, efficiency, and chatter events, using the Centurion® Vision system.Eighty porcine eyes were randomized into 4 groups: 1sleeveless conventional 45D MiniFlared ABS® Kelman tip (1.1-mm incision; 2sleeveless new modified 45D ABS® INTREPID® balanced tip(1.1-mm incision; 3 Kelman tip with own sleeve (2.2-mm incision; 4Balanced tip with modified 4-rib sleeve (2.2-mm incision. Measurements were taken with 2 settings: longitudinal(power 40% and 70% and torsional mode (power 40% and 100%. Peak temperatures were measured 0, 10, 30, and 60 seconds after continuous ultrasound power. For the efficiency test, porcine lens nuclei were formalin soaked and cut into 2.0 mm3 cubes. Efficiency and chatter were examined.In all longitudinal settings, the sleeveless groups(1 and 2 showed lower temperatures than the sleeved groups(3 and 4 (P = 0.003. In 100% torsional mode, groups 3 and 4 produced significantly different temperatures(37.13 ± 1.44 and 35.14 ± 0.54, respectively; P = 0.007.The efficiency, in a 100% power torsional setting, was13.52 ± 2.60 sec for group 4, and 44.45± 14.75 sec for group 3 (P<0.001.The two different bare tips show no significant differences in thermogenesis. However, the balanced tip with sleeve produces lower temperaturesat100% torsional power and better efficiency than the Kelman tip.

  11. Report covering examination of parts from downhole steam generators. [Combustor head and sleeve parts

    Energy Technology Data Exchange (ETDEWEB)

    Pettit, F. S.; Meier, G. H.

    1983-08-01

    Combustor head and sleeve parts were examined by using optical and scanning electron metallography after use in oxygen/diesel and air/diesel downhole steam generators. The degradation of the different alloy components is described in terms of reactions with oxygen, sulfur and carbon in the presence of cyclic stresses, all generated by the combustion process. Recommendations are presented for component materials (alloys and coatings) to extend component lives in the downhole steam generators. 9 references, 22 figures, 3 tables.

  12. Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer.

    Science.gov (United States)

    Hamabe, Atsushi; Omori, Takeshi; Tanaka, Koji; Nishida, Toshirou

    2012-06-01

    Laparoscopy-assisted gastrectomy (LAG) has been established as a low-invasive surgery for early gastric cancer. However, it remains unknown whether it is applicable also for advanced gastric cancer, mainly because the long-term results of LAG with D2 lymph node dissection for advanced gastric cancer have not been well validated compared with open gastrectomy (OG). A retrospective cohort study was performed to compare LAG and OG with D2 lymph node dissection. For this study, 167 patients (66 LAG and 101 OG patients) who underwent gastrectomy with D2 lymph node dissection for advanced gastric cancer were reviewed. Recurrence-free survival and overall survival time were estimated using Kaplan-Meier curves. Stratified log-rank statistical evaluation was used to compare the difference between the LAG and OG groups stratified by histologic type, pathologic T status, N status, and postoperative adjuvant chemotherapy. The adjusted Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of LAG. The 5-year recurrence-free survival rate was 89.6% in the LAG group and 75.8% in the OG group (nonsignificant difference; stratified log-rank statistic, 3.11; P = 0.0777). The adjusted HR of recurrence for LAG compared with OG was 0.389 [95% confidence interval (CI) 0.131-1.151]. The 5-year overall survival rate was 94.4% in the LAG group and 78.5% in the OG group (nonsignificant difference; stratified log-rank statistic, 0.4817; P = 0.4877). The adjusted HR of death for LAG compared with OG was 0.633 (95% CI 0.172-2.325). The findings show that LAG with D2 lymph node dissection is acceptable in terms of long-term results for advanced gastric cancer cases and may be applicable for advanced gastric cancer treatment.

  13. Experimental consolidation of granulated rock salt with application to sleeve buckling. Technical memorandum report RSI-0044

    International Nuclear Information System (INIS)

    Hansen, F.D.

    1976-01-01

    Quasi-static and creep consolidation tests have been performed in order to determine the compressibility of granulated rock salt when subjected to uniaxial deformations. The purpose of this analysis is to evaluate the force-displacement characteristics of rock salt that may be used as a backfill material around waste canister sleeves. The test set-up involved placing rock salt pellets in a thin-walled steel cylinder and applying a uniaxial load which compressed the salt while allowing no lateral movement. Tests were run at room temperature, 100 and 200 0 C and consolidated to uniaxial stress levels between 1000 and 4000 psi. Axial force, displacement and time were monitored during each test and the relationships have been evaluated. In particular, compressibility of the rock salt is not drastically effected by the temperature differences, nor is there an appreciable difference between the consolidation tests that were allowed to creep and those that were tested quasi-statically. On the basis of experimental data relating volume change to uniaxial stress, the pressure on the waste canister sleeve has been shown to be a nonlinear function of drillhole displacement. For a proposed in situ field test geometry, a 16 inch drillhole and a canister with a 12.75 inch O.D., the pressure necessary to buckle the canister sleeve will develop when the drillhole closes diametrically 0.5 to 0.6 inches. By the nature of this experimental effort, the results obtained are conservative

  14. Modified sleeve anastomosis for reconstruction of the hepatic artery in rat liver transplantation.

    Science.gov (United States)

    Li, Jun; Dahmen, Uta; Dirsch, Olaf; Shen, Kai; Gu, Yanli; Broelsch, Christoph Erich

    2002-01-01

    End-to-end sleeve anastomosis between a donor common hepatic artery and a recipient proper hepatic artery was proven to be the most physiological and simple method for hepatic rearterialization in rat liver transplantation. Current technical variants of the sleeve technique, however, are hampered by the high rate of bleeding from the anastomotic site. This report deals with a technical modification which inhibits postoperative bleeding efficiently. The procedure consisted of a guiding suture, as previously described in other technical variants, and a modified fixing suture. Instead of using a single stitch to fix the feeding vessel with the receiving vessel, a running suture between the edge of the donor common hepatic artery and the adventitia of the recipient proper hepatic artery was performed to avoid a possible backflow. The patency rate of 91% was as high as reported by others using a sleeve technique, which was also reflected in the histomorphological picture, being indistinguishable from normal liver histology. This technical modification simplified the procedure of reconstructing the hepatic artery and could contribute to a wider use of the arterialized liver transplantation model in rats. Copyright 2002 Wiley-Liss, Inc.

  15. The efficacy of sleeve technique in primary nasolacrimal duct obstruction with a high lacrimal sac

    Directory of Open Access Journals (Sweden)

    Kyoung-Nam Kim

    2014-01-01

    Full Text Available Purpose: To evaluate the efficacy of a sleeve technique during endoscopic dacryocystorhinostomy (DCR in primary nasolacrimal duct obstruction (NLDO patients with a high lacrimal sac. Materials and Methods: The medical records of 45 patients (49 cases undergoing endoscopic DCR for primary NLDO with a high lacrimal sac were retrospectively reviewed. In 19 patients (21 cases, the thick maxilla covering the common canalicular opening was removed using a drill and a bicanalicular silicone tube was inserted (group 1. In 26 patients (28 cases, instead of removal of the thick maxilla, a sleeve was inserted into the bicanalicular silicone tube (group 2. At 6 months postoperatively, the success rate was evaluated and the size of the intranasal mucosal ostium was measured. Results: The success rates in group 1 and 2 was 90.5% and 96.4%, respectively (P = 0.400. The intranasal mucosal ostium in group 1 and 2 measured 1.7 ± 0.7 mm and 3.1 ± 1.0 mm, respectively, and the difference was significant (P = 0.042. Conclusions: In primary NLDO patients with a high lacrimal sac, DCR inserting a silicone tube and a sleeve together had a satisfactory success rate without using a drill. In comparison with traditional surgical methods, it helped enlarge the size of the intranasal mucosal ostium.

  16. Basic interrupted versus continuous suturing techniques in bronchial anastomosis following sleeve lobectomy in dogs.

    Science.gov (United States)

    Bayram, Ahmet Sami; Erol, Mehmet Muharrem; Salci, Hakan; Ozyiğit, Ozgür; Görgül, Sacit; Gebitekin, Cengiz

    2007-12-01

    Sleeve resection with or without lung resection is a valid conservative operation for patients with benign or malignant tumors; it enables the preservation of lung parenchyma. The aim of this prospective randomized study was to compare complications, operating time, and bronchial healing between the techniques of interrupted and continuous suturing for bronchial anastomosis in dogs. Twenty adult mongrel dogs each weighing 18-22 kg (average: 20 kg) were divided into two groups according to the anastomosis technique performed: group A, interrupted suturing and group B, continuous suturing. Each group comprised of 10 dogs. Following right thoracotomy, sleeve resection of the right cranial lobe was performed in all dogs. Basic interrupted sutures using 4/0 Vicryl (Ethicon, USA) were used in group A, and continuous sutures were used in group B. The median anastomosis time was 15.2 min (range: 13-21 min) in group A and 9.6 min (range: 8-13 min) in group B. In all dogs, the anastomosis line was resected via right pneumonectomy for histopathological investigation 1 month after sleeve resection. Histopathological examination revealed that the healing of the anastomosis was not affected by the suturing technique applied. One dog from each group died on the fourth postoperative day; Fisher's exact test, p=0.763. Our research revealed that the healing of the anastomosis was not affected by the suturing technique performed.

  17. Percutaneous Trans-hepatic Obliteration for Bleeding Esophagojejunal Varices After Total Gastrectomy and Esophagojejunostomy

    International Nuclear Information System (INIS)

    Boku, Michiko; Sugimoto, Koji; Nakamura, Tetsu; Kita, Yasufumi; Zamora, Carlos A.; Sugimura, Kazuro

    2006-01-01

    A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy

  18. Evaluation of the effect of nasogastric intubation on gastrointestinal function after gastrectomy in gastric cancer patients

    Directory of Open Access Journals (Sweden)

    Chamanzari Hamid

    2016-08-01

    Full Text Available Background and Objective: The optimal treatment strategy for patients with gastric cancer is gastrectomy. Typically, nasogastric intubation is used after this type of surgery to feed patients; however, there seems to be no unanimity of opinion on this topic. Therefore, this study aimed to evaluate the effect of nasogastric intubation on gastrointestinal function after gastrectomy in gastric cancer patients. Materials and Method: This clinical trial was conducted on gastric cancer patients, admitted to the general ward of Imam Reza Hospital in Mashhad, Iran in 2015. In total, 68 patients were selected through randomized convenience sampling and divided into two intervention and control groups of 34 individuals. Nasogastric tube insertion was applied for the intervention group after the surgery. Patients of the study groups were fasted for three days after the surgery, which was followed by the removal of nasogastric tubes and initiation of oral feeding. Gastrointestinal function of all the participants was evaluated six hours after transferring to the ward up to seven days after the surgery on a daily basis using nausea and vomiting assessment tools and researcher-made questionnaire of gastrointestinal function. Data analysis was performed in SPSS version 16 using Fisher’s exact test, Chi-square, Mann-Whitney U, repeated measures ANOVA and paired t-test. Results: In this study, the severity of nausea and vomiting, the first time of passing gas and severity of flatulence Intensity were less observed in the control group, compared to the intervention group. Moreover, postoperative food tolerance was higher in the patients of the control group, compared to the other study group (P<0.05. Conclusion: According to the results of this study, nasogastric intubation can delay normal gastrointestinal function after gastrectomy. Therefore, it is not recommended to use this method after gastrectomy.

  19. Feasibility of a Clinical Pathway with Early Oral Intake and Discharge for Laparoscopic Gastrectomy.

    Science.gov (United States)

    Nakagawa, M; Tomii, C; Inokuchi, M; Otsuki, S; Kojima, K

    2017-12-01

    Although some studies have reported the safety of early oral intake after gastrectomy, it still remains controversial. This study focused on the feasibility of a clinical pathway with early oral intake and discharge setting for exclusively laparoscopic distal gastrectomy. A clinical pathway was applied to 403 patients until December 2014. In the protocol, patients are allowed to take a sip of water and a soft diet on the first and second days after the operation, respectively, and the discharge day is set as the fifth to seventh day after the operation. Clinicopathological variables were prospectively collected, and risk factors for discharge variances were analyzed. The completion rate of the clinical pathway was 76.9%. There were five re-admissions (1.2%). The overall morbidity rate was 18% ( n = 72), and major complications (Clavien-Dindo IIIa or greater) occurred in 13 patients (3%). Complications were the causes for discharge variances in 68 cases (73%), while the attending surgeons' judgment was the cause in 25 cases (27%). On multivariate analysis, age (odds ratio = 2.23, 95% confidence interval = 1.38-3.60, p = 0.001) and operative time (odds ratio = 2.38, 95% confidence interval = 1.45-3.98, p = 0.001) were independent risk factors for discharge variances. A high completion rate of a clinical pathway with early oral intake and discharge setting for laparoscopic distal gastrectomy was achievable with an acceptably low re-admission rate. Laparoscopic distal gastrectomy is recommended as a first step for a clinical pathway with an early oral intake and discharge protocol.

  20. Prevalence of Upper Abdominal Complaints in Patients Who Have Undergone Partial Gastrectomy

    Directory of Open Access Journals (Sweden)

    RJLF Loffeld

    2000-01-01

    Full Text Available Little is known about the long term occurrence and prevalence of upper abdominal complaints after previous partial gastrectomy. Therefore, a retrospective, uncontrolled, cross-sectional, descriptive, clinical, endoscopic study was done. A questionnaire was mailed to patients who had undergone partial gastrectomy and been sent for upper gastrointestinal endoscopy. Eight questions were scored on a five-point Likert scale, and a symptom score was calculated. During the five-year study period, 189 patients (137 men, 52 women were identified as having had a partial gastrectomy -- 143 (76% received the Billroth II operation and 46 (24% received the Billroth I operation. The questionnaire was mailed to 124 patients, of whom 79 (64% responded. Eighty-eight per cent of patients had undergone surgery more than 15 years earlier. Fifty-nine patients (75% suffered from upper abdominal symptoms. Regurgitation of food, retrosternal heartburn and bile reflux occurred significantly more often in patients who underwent the Billroth II operation. The mean symptom score of patients who underwent Billroth I resection was significantly lower (4.5 [SD 3.6] than that of patients who underwent Billroth II resection (7.1 [SD 4.4](P=0.04. One or more symptoms indicative of dumping were found in 70% of patients who underwent Billroth II resection and in 59% of patients who underwent Billroth I resection (not significant. Many patients who had undergone a partial gastrectomy developed upper abdominal symptoms during long term follow-up that were not specifically linked to dumping.

  1. Impact of gastrectomy procedural complexity on surgical outcomes and hospital comparisons.

    Science.gov (United States)

    Mohanty, Sanjay; Paruch, Jennifer; Bilimoria, Karl Y; Cohen, Mark; Strong, Vivian E; Weber, Sharon M

    2015-08-01

    Most risk adjustment approaches adjust for patient comorbidities and the primary procedure. However, procedures done at the same time as the index case may increase operative risk and merit inclusion in adjustment models for fair hospital comparisons. Our objectives were to evaluate the impact of surgical complexity on postoperative outcomes and hospital comparisons in gastric cancer surgery. Patients who underwent gastric resection for cancer were identified from a large clinical dataset. Procedure complexity was characterized using secondary procedure CPT codes and work relative value units (RVUs). Regression models were developed to evaluate the association between complexity variables and outcomes. The impact of complexity adjustment on model performance and hospital comparisons was examined. Among 3,467 patients who underwent gastrectomy for adenocarcinoma, 2,171 operations were distal and 1,296 total. A secondary procedure was reported for 33% of distal gastrectomies and 59% of total gastrectomies. Six of 10 secondary procedures were associated with adverse outcomes. For example, patients who underwent a synchronous bowel resection had a higher risk of mortality (odds ratio [OR], 2.14; 95% CI, 1.07-4.29) and reoperation (OR, 2.09; 95% CI, 1.26-3.47). Model performance was slightly better for nearly all outcomes with complexity adjustment (mortality c-statistics: standard model, 0.853; secondary procedure model, 0.858; RVU model, 0.855). Hospital ranking did not change substantially after complexity adjustment. Surgical complexity variables are associated with adverse outcomes in gastrectomy, but complexity adjustment does not affect hospital rankings appreciably. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Ectopic jejunal pacemakers and gastric emptying after Roux gastrectomy: Effect of intestinal pacing

    International Nuclear Information System (INIS)

    Karlstrom, L.; Kelly, K.A.

    1989-01-01

    The aims of this study were to determine whether ectopic pacemakers are present after meals in the Roux limbs of dogs after vagotomy and Roux gastrectomy, whether these pacemakers slow gastric emptying of liquids or solids, and whether abolishing the pacemakers with electric pacing might speed any slow emptying that occurs. In six dogs that underwent vagotomy and Roux gastrectomy and in four dogs that underwent vagotomy and Billroth gastrectomy (controls), myoelectric activity of the Roux limb or duodenum was measured during gastric emptying of a 500 kcal mixed meal of 99mTc-labeled cooked egg and 111In-labeled milk. Roux dogs were tested with and without pacing of the Roux limb. Roux dogs showed ectopic pacemaker in the Roux limb that drove the pacesetter potentials of the limb in a reverse, or orad, direction during 57% of the postprandial recordings. Billroth dogs had no ectopic pacemakers (p less than 0.05). Liquids emptied more slowly in Roux dogs (half-life (t1/2) = 121 +/- 15 minutes) than in Billroth dogs (t1/2 = 43 +/- 9 minutes; p less than 0.05), but solids emptied similarly in both groups of dogs (t1/2 approximately 8 hours). Pacing the Roux limb abolished the ectopic pacemakers, restored the slow emptying of liquids to the more rapid rate found in the Billroth dogs (t1/2: paced Roux, 72 +/- 15 minutes; Billroth, 43 +/- 9 minutes; p greater than 0.05) and did not change emptying of solids. The conclusion was that ectopic pacemakers present in the Roux limb after vagotomy and Roux gastrectomy drove the limb in a reverse direction and slowed emptying of liquids after the operation. The defect was corrected by pacing the Roux limb in a forward direction

  3. CT evaluation of bone mineral density (BMD) of lumbar spine in patients after gastrectomy

    International Nuclear Information System (INIS)

    Ito, Masako; Hayashi, Kuniaki; Uetani, Masataka; Eto, Toshifumi; Matsumoto, Teiji; Yamada, Naoyuki.

    1990-01-01

    The late postoperative complications in patients after gastrectomy include anemia and metabolic bone disorders. We studied to determine whether gastric surgery is associated with metabolic bone disease. Vertebral BMD was measured in 55 patients after gastric resection by using DEQCT (dual energy quantitative CT). Forty patients were symptomatic, having bone or joint pain, history of bone fracture, or dental caries. The control group consisted of 161 patients without metabolic bone disorders. Forty percent of the patients with either the symptoms or history of bone fracture or dental caries, and 20% of the patients without the symptoms or the history showed decreased BMD. BMD was significantly lower in males in their 60s and in females in their 50s and 70s than BMD in age-matched control groups. When male subjects were grouped according to the years following the operation (1-5, 6-10, 11-15, 16-20 years), BMD was found to be decreased in 27%, 29%, 40% and 50% of the patients in each group, respectively, and the degree of the decrease tended to be greater with increasing time after surgery. Higher incidence of decreased BMD was found in the patients after total gastrectomy when compared with those after subtotal gastrecotmy. Among the patients with subtotal gastrectomy, the incidence of decreased BMD was higher in patients with Billroth II anastomosis than in those with Billroth I anastomosis. In cases with compression fracture on thoracolumbar radiographs, BMD was significantly lower in comparison with cases with no fracture. It was difficult to differentiate between osteomalacia and osteoporosis only by the thoracolumbar radiographs. While the clinical information such as patients' complaints, histories of fracture and laboratory findings are important to evaluate the bone changes following gastric resection. BMD measurement is most useful in quantitatively determining the degree of bone loss after gastrectomy. (author)

  4. Ectopic jejunal pacemakers and gastric emptying after Roux gastrectomy: Effect of intestinal pacing

    Energy Technology Data Exchange (ETDEWEB)

    Karlstrom, L.; Kelly, K.A. (Mayo Clinic, Rochester, MN (USA))

    1989-11-01

    The aims of this study were to determine whether ectopic pacemakers are present after meals in the Roux limbs of dogs after vagotomy and Roux gastrectomy, whether these pacemakers slow gastric emptying of liquids or solids, and whether abolishing the pacemakers with electric pacing might speed any slow emptying that occurs. In six dogs that underwent vagotomy and Roux gastrectomy and in four dogs that underwent vagotomy and Billroth gastrectomy (controls), myoelectric activity of the Roux limb or duodenum was measured during gastric emptying of a 500 kcal mixed meal of 99mTc-labeled cooked egg and 111In-labeled milk. Roux dogs were tested with and without pacing of the Roux limb. Roux dogs showed ectopic pacemaker in the Roux limb that drove the pacesetter potentials of the limb in a reverse, or orad, direction during 57% of the postprandial recordings. Billroth dogs had no ectopic pacemakers (p less than 0.05). Liquids emptied more slowly in Roux dogs (half-life (t1/2) = 121 +/- 15 minutes) than in Billroth dogs (t1/2 = 43 +/- 9 minutes; p less than 0.05), but solids emptied similarly in both groups of dogs (t1/2 approximately 8 hours). Pacing the Roux limb abolished the ectopic pacemakers, restored the slow emptying of liquids to the more rapid rate found in the Billroth dogs (t1/2: paced Roux, 72 +/- 15 minutes; Billroth, 43 +/- 9 minutes; p greater than 0.05) and did not change emptying of solids. The conclusion was that ectopic pacemakers present in the Roux limb after vagotomy and Roux gastrectomy drove the limb in a reverse direction and slowed emptying of liquids after the operation. The defect was corrected by pacing the Roux limb in a forward direction.

  5. CT evaluation of bone mineral density (BMD) of lumbar spine in patients after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Masako; Hayashi, Kuniaki; Uetani, Masataka; Eto, Toshifumi; Matsumoto, Teiji (Nagasaki Univ. (Japan). School of Medicine); Yamada, Naoyuki

    1990-11-01

    The late postoperative complications in patients after gastrectomy include anemia and metabolic bone disorders. We studied to determine whether gastric surgery is associated with metabolic bone disease. Vertebral BMD was measured in 55 patients after gastric resection by using DEQCT (dual energy quantitative CT). Forty patients were symptomatic, having bone or joint pain, history of bone fracture, or dental caries. The control group consisted of 161 patients without metabolic bone disorders. Forty percent of the patients with either the symptoms or history of bone fracture or dental caries, and 20% of the patients without the symptoms or the history showed decreased BMD. BMD was significantly lower in males in their 60s and in females in their 50s and 70s than BMD in age-matched control groups. When male subjects were grouped according to the years following the operation (1-5, 6-10, 11-15, 16-20 years), BMD was found to be decreased in 27%, 29%, 40% and 50% of the patients in each group, respectively, and the degree of the decrease tended to be greater with increasing time after surgery. Higher incidence of decreased BMD was found in the patients after total gastrectomy when compared with those after subtotal gastrecotmy. Among the patients with subtotal gastrectomy, the incidence of decreased BMD was higher in patients with Billroth II anastomosis than in those with Billroth I anastomosis. In cases with compression fracture on thoracolumbar radiographs, BMD was significantly lower in comparison with cases with no fracture. It was difficult to differentiate between osteomalacia and osteoporosis only by the thoracolumbar radiographs. While the clinical information such as patients' complaints, histories of fracture and laboratory findings are important to evaluate the bone changes following gastric resection. BMD measurement is most useful in quantitatively determining the degree of bone loss after gastrectomy. (author).

  6. Endoscopy-guided balloon dilation of benign anastomotic strictures after radical gastrectomy for gastric cancer.

    Science.gov (United States)

    Lee, Hyun Jik; Park, Wan; Lee, Hyuk; Lee, Keun Ho; Park, Jun Chul; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan; Noh, Sung Hoon

    2014-07-01

    The aim of this study was to evaluate the outcome of endoscopic dilation for benign anastomotic stricture after radical gastrectomy in gastric cancer patients. Gastric cancer patients who underwent endoscopic balloon dilation for benign anastomosis stricture after radical gastrectomy during a 6-year period were reviewed retrospectively. Twenty-one patients developed benign strictures at the site of anastomosis. The majority of strictures occurred within 1 year after surgery (95.2%). The median duration to stenosis after surgery was 1.70 months (range, 0.17 to 23.97 months). The success rate of the first endoscopic dilation was 61.9%. Between the restenosis group (n=8) and the no restenosis group (n=13), there were no significant differences in the body mass index (22.82 kg/m(2) vs 22.46 kg/m(2)), interval to symptom onset (73.9 days vs 109.3 days), interval to treatment (84.6 days vs 115.6 days), maximal balloon diameter (14.12 mm vs 15.62 mm), number of balloon dilation sessions (1.75 vs 1.31), location of gastric cancer or type of surgery. One patient required surgery because of stricture refractory to repeated dilation. Endoscopic dilation is a highly effective treatment for benign anastomotic strictures after radical gastrectomy for gastric cancer and should be considered a primary intervention prior to proceeding with surgical revision.

  7. Endoscopic retrograde cholangiopancreatography after Billroth-Ⅱ gastrectomy and its safety

    Directory of Open Access Journals (Sweden)

    LEI Ting

    2016-06-01

    Full Text Available ObjectiveTo investigate the safety of endoscopic retrograde cholangiopancreatography (ERCP after Billroth-Ⅱ gastrectomy. MethodsA total of 43 patients who were admitted to our hospital and underwent Billroth-Ⅱ gastrectomy from June 2012 to June 2015 were enrolled and underwent ERCP. ResultsOf all 43 patients undergoing ERCP, 39 (90.7% received successful intubation, 2 (4.7% received failed intubation, and 2 (47% experienced the complication of digestive tract perforation. Among the 39 patients who underwent ERCP, 31 (79.5% were diagnosed with common bile duct stones (3 underwent sphincterotomy and 28 underwent endoscopic papillary balloon dilation to remove stones, 6 (15.4% were diagnosed with benign stenosis at the end of bile duct (4 underwent papillary balloon dilation alone and 2 underwent biliary plastic stent implantation, and 1 patient each (2.6% was diagnosed with ampullary tumor and hepatic portal metastasis of gastric cancer and received implantation of metal and plastic stents, respectively. One patient (26% experienced acute pancreatitis after surgery. ConclusionERCP is safe and effective in patients after Billroth-Ⅱ gastrectomy and holds promise for clinical application.

  8. Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

    Directory of Open Access Journals (Sweden)

    Portanova Michel

    2010-08-01

    Full Text Available Abstract Background Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Methods Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent total gastrectomy, 9 of them had esophagojejunal fistula (5.2%. In three selected patients a trans-anastomotic naso-enteral feeding tube was placed under fluoroscopic vision when the fistula was clinically detected and a complete polymeric enteral formula was used. Results The complete closing of the esophagojejunal fistula was obtained in day 8, 14 and 25 respectively. Conclusion In some selected cases it is possible to make a successful enteral nutrition using a feeding tube distal to the leak area inserted with the help of fluoroscopic vision. The specialized management of a gastric surgery unit and nutritional therapy unit are highlighted.

  9. Endoscopic Retrograde Cholangiopancreatography Using a Dual-Lumen Endogastroscope for Patients with Billroth II Gastrectomy

    Directory of Open Access Journals (Sweden)

    Wei Yao

    2013-01-01

    Full Text Available Objective. To evaluate the safety and efficacy of a dual-lumen forward-viewing endoscope for ERCP in patients with prior Billroth II gastrectomy. Methods. The records of 46 patients treated with ERCP by a dual-lumen forward-viewing endoscope after Billroth II gastrectomy from 2007 to 2012 were reviewed. Results. The success rate of selective cannulation was 82.6% (38/46. Of the 38 cases with successful selective cannulation, endoscopic sphincterotomy was achieved in 23 cases by placing the needle knife through the 2nd lumen, while endoscopic papillary balloon dilatation was conducted in the other 15 cases. Of the 8 failed cases of selective cannulation, 6 had failed afferent loop intubation, and 3 of these 6 patients had Braun’s anastomosis. The safety and efficacy of catheter-assisted endoscopic sphincterotomy were increased by placing the needle knife through the 2nd lumen without altering the conventional endoscopic sphincterotomy procedure. Conclusions. A dual-lumen forward-viewing endoscope can be safely and effectively used to perform ERCP in patients with a Billroth II gastrectomy, except for patients with additional Braun’s anastomosis.

  10. Comparative evaluation of two reconstructive methods following laparoscopic assisted subtotal gastrectomy in dogs

    Directory of Open Access Journals (Sweden)

    Bakhtiari Jalal

    2012-12-01

    Full Text Available Abstract Background Laparoscopic gastrectomy is a new and technically challenging surgical procedure with potential benefit. The objective of this study was to investigate clinical and para-clinical consequences following Roux-en-Y and Jejunal Loop interposition reconstructive techniques for subtotal gastrectomy using laparoscopic assisted surgery. Results Following resection of the stomach attachments through a laparoscopic approach, stomach was removed and reconstruction was performed with either standard Roux-en-Y (n = 5 or Jejunal Loop interposition (n = 5 methods. Weight changes were monitored on a daily basis and blood samples were collected on Days 0, 7 and 21 post surgery. A fecal sample was collected on Day 28 after surgery to evaluate fat content. One month post surgery, positive contrast radiography was conducted at 5, 10, 20, 40, 60 and 90 minutes after oral administration of barium sulfate, to evaluate the postoperative complications. There was a gradual decline in body weight in both experimental groups after surgery (P  0.05. Fecal fat content increased in the Roux-en-Y compared to the Jejunal loop interposition technique (P  0.05. Conclusion Roux-en-Y and Jejunal loop interposition techniques might be considered as suitable approaches for reconstructing gastro-intestinal tract following gastrectomy in dogs. The results of this study warrant further investigation with a larger number of animals.

  11. Routine Use of Contrast Swallow After Total Gastrectomy and Esophagectomy: Is it Justified?

    Science.gov (United States)

    El-Sourani, Nader; Bruns, Helge; Troja, Achim; Raab, Hans-Rudolf; Antolovic, Dalibor

    2017-01-01

    After gastrectomy or esophagectomy, esophagogastrostomy and esophagojejunostomy are commonly used for reconstruction. Water-soluble contrast swallow is often used as a routine screening to exclude anastomotic leakage during the first postoperative week. In this retrospective study, the sensitivity and specificity of oral water-soluble contrast swallow for the detection of anastomotic leakage and its clinical symptoms were analysed. Records of 104 consecutive total gastrectomies and distal esophagectomies were analysed. In all cases, upper gastrointestinal contrast swallow with the use of a water-soluble contrast agent was performed on the 5 th postoperative day. Extravasation of the contrast agent was defined as anastomotic leakage. When anastomotic insufficiency was suspected but no extravasation was present, a computed tomography (CT) scan and upper endoscopy were performed. Oral contrast swallow detected 7 anastomotic leaks. Based on CT-scans and upper endoscopy, the true number of anastomotic leakage was 15. The findings of the oral contrast swallow were falsely positive in 4 and falsely negative in 12 patients, respectively. The sensitivity and specificity of the oral contrast swallow was 20% and 96%, respectively. Routine radiological contrast swallow following total gastrectomy or distal esophagectomy cannot be recommended. When symptoms of anastomotic leakage are present, a CT-scan and endoscopy are currently the methods of choice.

  12. Influence of Elastic Bandage and Neoprene Sleeve on Knee Position Sense and Pain in Subjects with Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Basir Majdoleslami

    2003-12-01

    Full Text Available Objective: to investigate whether a neoprene sleeve and elastic bandage around the knee joint of subjects with knee osteoarthritis (OA would , in short term (a reduce pain (b improve knee joint position sense and comparison of their effect with each other if they have. Materials & Methods: In a semi-experimental study, 30 subjects (11 men, 19 women, age between 33-75 with unilateral knee OA. Subjects had to have at least 2cm from 10cm visual analogue scale (VAS of knee pain for study entry.All patients were randomly assigned to either an elastic bandage or a neoprene sleeve. One week later they were assigned to the opposite selection. Joint position sense was assessed in the sitting position using an electrogoniometer and pain by VAS where 0cm equals no pain and 10 cm equals worst pain. Knee pain and JPS were assessed for each selection one week apart. During each visit assessment were performed at baseline and after 20 min of bandage/neoprene sleeve application. Results: the mean of scores for knee variables JPS and VAS was taken and paired-t test and Wilcoxon signed rank test was employed to calculate the different between two trails. Neoprene sleeve had significant effect on knee JPS (P=0.037. But elastic bandage had no effect (P=0.631. Both of them had significantly reduced knee pain. (P=0.000 Conclusion: In subjects with both neoprene sleeve and elastic bandage reduced knee pain with more effect of neoprene sleeve. Only the neoprene sleeve had effect on knee JPS.

  13. Association of Hospital Costs With Complications Following Total Gastrectomy for Gastric Adenocarcinoma.

    Science.gov (United States)

    Selby, Luke V; Gennarelli, Renee L; Schnorr, Geoffrey C; Solomon, Stephen B; Schattner, Mark A; Elkin, Elena B; Bach, Peter B; Strong, Vivian E

    2017-10-01

    Postoperative complications are associated with increased hospital costs following major surgery, but the mechanism by which they increase cost and the categories of care that drive this increase are poorly described. To describe the association of postoperative complications with hospital costs following total gastrectomy for gastric adenocarcinoma. This retrospective analysis of a prospectively collected gastric cancer surgery database at a single National Cancer Institute-designated comprehensive cancer center included all patients undergoing curative-intent total gastrectomy for gastric adenocarcinoma between January 2009 and December 2012 and was conducted in 2015 and 2016. Ninety-day normalized postoperative costs. Hospital accounting system costs were normalized to reflect Medicare reimbursement levels using the ratio of hospital costs to Medicare reimbursement and categorized into major cost categories. Differences between costs in Medicare proportional dollars (MP $) can be interpreted as the amount that would be reimbursed to an average hospital by Medicare if it paid differentially based on types and extent of postoperative complications. In total, 120 patients underwent curative-intent total gastrectomy for stage I through III gastric adenocarcinoma between 2009 and 2012. Of these, 79 patients (65.8%) were men, and the median (interquartile range) age was 64 (52-70) years. The 51 patients (42.5%) who underwent an uncomplicated total gastrectomy had a mean (SD) normalized cost of MP $12 330 (MP $2500), predominantly owing to the cost of surgical care (mean [SD] cost, MP $6830 [MP $1600]). The 34 patients (28.3%) who had a major complication had a mean (SD) normalized cost of MP $37 700 (MP $28 090). Surgical care was more expensive in these patients (mean [SD] cost, MP $8970 [MP $2750]) but was a smaller contributor to total cost (24%) owing to increased costs from room and board (mean [SD] cost, MP $11 940 [MP $8820]), consultations (mean [SD

  14. Thermoelastic/plastic analysis of waste-container sleeve: III. Influence of salt strength on sleeve loading. Technical memorandum report (RSI-0018)

    International Nuclear Information System (INIS)

    Pariseau, W.G.

    1975-01-01

    Three combinations of salt tensile, compressive and shear strength in linear and nonlinear yield conditions used in the axially symmetric, large displacement thermoelastic/plastic waste-container/sleeve loading estimates show no influence on the analysis. The salt remains elastic throughout the excavation and subsequent 10 year heating period. Tensile stresses are not observed, tensile strength is thus not important to the analysis even at 10 percent of the compressive strength value. Although strictly applicable only to the conditions of the analyses reported here, the capability for incorporating arbitrary strength combinations in linear or non-linear yield conditions is demonstrated. Computer plots of principal stresses and displacement fields at various stages of the excavation and heating simulation aid in the visualization of repository concept mechanics and show the possible need for additional mesh refinement for more precise stress information

  15. Hemodynamic effect and safety of intermittent sequential pneumatic compression leg sleeves in patients with congestive heart failure.

    Science.gov (United States)

    Bickel, Amitai; Shturman, Alexander; Sergeiev, Michael; Ivry, Shimon; Eitan, Arieh; Atar, Shaul

    2014-10-01

    Pneumatic leg sleeves are widely used after prolonged operations for prevention of venous stasis. In healthy volunteers they increase cardiac function. We evaluated the hemodynamic effects and safety of intermittent sequential pneumatic compression (ISPC) leg sleeves in patients with chronic congestive heart failure (CHF). We studied 19 patients with systolic left ventricular dysfunction and CHF. ISPC leg sleeves, each with 10 air cells, were operated by a computerized compressor, exerting 2 cycles/min. Hemodynamic and echocardiographic parameters were measured before, during, and after ISPC activation. The baseline mean left ventricular ejection fraction was 29 ± 9.2%, median 32%, range 10%-40%. Cardiac output (from 4.26 to 4.83 L/min; P = .008) and stroke volume (from 56.1 to 63.5 mL; P = .029) increased significantly after ISPC activation, without a reciprocal increase in heart rate, and declined after sleeve deactivation. Systemic vascular resistance (SVR) decreased significantly (from 1,520 to 1,216 dyne-s/cm5; P = .0005), and remained lower than the baseline level throughout the study. There was no detrimental effect on diastolic function and no adverse clinical events, despite increased pulmonary venous return. ISPC leg sleeves in patients with chronic CHF do not exacerbate symptoms and transiently improve cardiac output through an increase in stroke volume and a reduction in SVR. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection for non-small cell lung cancer.

    Science.gov (United States)

    Li, Shuben; Chai, Huiping; Huang, Jun; Zeng, Guangqiao; Shao, Wenlong; He, Jianxing

    2014-04-01

    The purpose of the current study is to present the clinical and surgical results in patients who underwent hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection. Thirty-one patients, 27 men and 4 women, underwent segmental-main bronchial sleeve anastomoses for non-small cell lung cancer between May 2004 and May 2011. Twenty-six (83.9%) patients had squamous cell carcinoma, and 5 patients had adenocarcinoma. Six patients were at stage IIB, 24 patients at stage IIIA, and 1 patient at stage IIIB. Secondary sleeve anastomosis was performed in 18 patients, and Y-shaped multiple sleeve anastomosis was performed in 8 patients. Single segmental bronchiole anastomosis was performed in 5 cases. The average time for chest tube removal was 5.6 days. The average length of hospital stay was 11.8 days. No anastomosis fistula developed in any of the patients. The 1-, 2-, and 3-year survival rates were 83.9%, 71.0%, and 41.9%, respectively. Hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection is a complex technique that requires training and experience, but it is an effective and safe operation for selected patients.

  17. Structure and properties of braided sleeve preforms for chemical vapor infiltration

    Energy Technology Data Exchange (ETDEWEB)

    Starr, T.L.; Fiadzo, O.G.; Hablutzel, N. [Georgia Inst. of Tech., Atlanta, GA (United States). School of Materials Science and Technology

    1998-04-01

    In all composites the properties and structure of the reinforcement strongly influence the performance of the material. For some composites, however, the reinforcement also affects the fabrication process itself exerting an additional, second order influence on performance. This is the case for the chemical vapor infiltration (CVI) process for fabrication of ceramic matrix composites. In this process the matrix forms progressively as a solid deposit, first onto the fiber surfaces, then onto the previous layer of deposit, ultimately growing to fill the inter-fiber porosity. The transport of reactants to the surfaces and the evolved morphology of the matrix depend on the initial reinforcement structure. This structure can vary greatly and is controlled by such factors as fiber size and cross-section, the number of filaments and amount of twist per tow or yarn, and the weave or braid architecture. Often the choice of reinforcement is based on mechanical performance analysis or on the cost and availability of the material or on the temperature stability of the fiber. Given this choice, the composite densification process--CVI--must be optimized to attain a successful material. Ceramic fiber in the form of cylindrical braided sleeve is an attractive choice for fabrication of tube-form ceramic matrix composites. Multiple, concentric layers of sleeve can be placed over a tubular mandrel, compressed and fixed with a binder to form a freestanding tube preform. This fiber architecture is different than that created by layup of plain weave cloth--the material used in most previous CVI development. This report presents the results of the investigation of CVI densification of braided sleeve preforms and the evolution of their structure and transport properties during processing.

  18. Congenital Constriction Band Syndrome

    OpenAIRE

    Rajesh Gupta, Fareed Malik, Rishabh Gupta, M.A.Basit, Dara Singh

    2008-01-01

    Congenital constriction bands are anomalous bands that encircle a digit or an extremity. Congenitalconstriction band syndrome is rare condition and is mostly associated with other musculoskeletaldisorders.We report such a rare experience.

  19. Repair boundary for parent tube indications within the upper joint zone of hybrid expansion joint (HEJ) sleeved tubes

    International Nuclear Information System (INIS)

    Cullen, W.K.; Keating, R.F.

    1997-01-01

    In the Spring and Fall of 1994, and the Spring of 1995, crack-like indications were found in the upper hybrid expansion joint (HEJ) region of Steam Generator (S/G) tubes which had been sleeved using Westinghouse HEJ sleeves. As a result of these findings, analytic and test evaluations were performed to assess the effect of the degradation on the structural, and leakage, integrity of the sleeve/tube joint relative to the requirements of the United States Nuclear Regulatory Commission's (NRC) draft Regulatory Guide (RG) 1.121. The results of these evaluations demonstrated that tubes with implied or known crack-like circumferential parent tube indications (PTIs) located 1.1 inches or farther below the bottom of the hardroll upper transition, have sufficient, and significant, integrity relative to the requirements of RG 1.121. Thus, the purpose of this report is to provide background information related to the justification of the modified tube repair boundary

  20. Axillary artery injury after an anterior shoulder fracture dislocation and “periosteal sleeve avulsion of the rotator cuff” (SARC. Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Ash Chehata

    2017-04-01

    Full Text Available We present the rare complication of an axillary artery injury associated with an anterior dislocation of the humerus and what we believe to be the first reported periosteal sleeve avulsion of the entire rotator cuff (SARC. We review the literature and discuss the cause of this unusual injury pattern. Keywords: Axillary artery, Shoulder fracture dislocation, Periosteal sleeve avulsion, SARC

  1. Abdominal drainage versus no drainage post-gastrectomy for gastric cancer.

    Science.gov (United States)

    Wang, Zhen; Chen, Junqiang; Su, Ka; Dong, Zhiyong

    2015-05-11

    Gastrectomy remains the primary therapeutic method for resectable gastric cancer. Thought of as an important measure to reduce post-operative complications and mortality, abdominal drainage has been used widely after gastrectomy for gastric cancer in previous decades. The benefits of abdominal drainage have been questioned by researchers in recent years. The objectives of this review were to assess the benefits and harms of routine abdominal drainage post-gastrectomy for gastric cancer. We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases (UGPD) Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2014, Issue 11); MEDLINE (via PubMed) (1950 to November 2014); EMBASE (1980 to November 2014); and the Chinese National Knowledge Infrastructure (CNKI) Database (1979 to November 2014). We included randomised controlled trials (RCTs) comparing an abdominal drain versus no drain in patients who had undergone gastrectomy (not considering the scale of gastrectomy and the extent of lymphadenectomy); irrespective of language, publication status, and the type of drain. We excluded RCTs comparing one drain with another. We adhered to the standard methodological procedures of The Cochrane Collaboration. From each included trial, we extracted the data on the methodological quality and characteristics of the participants, mortality (30-day mortality), re-operations, post-operative complications (pneumonia, wound infection, intra-abdominal abscess, anastomotic leak, drain-related complications), operation time, length of post-operative hospital stay, and initiation of a soft diet. For dichotomous data, we calculated the risk ratio (RR) and 95% confidence interval (CI). For continuous data, we calculated mean difference (MD) and 95% CI. We tested heterogeneity using the Chi(2) test. We used a fixed-effect model for data analysis with RevMan software, but we used a random-effects model if the P value of

  2. Effects of sleeve blockages on axial velocity and intensity of turbulence in an unheated 7 x 7 rod bundle

    International Nuclear Information System (INIS)

    Creer, J.M.; Rowe, D.S.; Bates, J.M.; Sutey, A.M.

    1976-01-01

    An experimental study is described which was performed to investigate the turbulent flow phenomena near postulated sleeve blockages in a model nuclear fuel rod bundle. The sleeve blockages were characteristic of fuel clad ''swelling'' or ''ballooning'' which could occur during loss-of-coolant accidents (LOCA) in pressurized water reactors. The study was conducted to provide information relative to the flow phenomena near postulated blockages to support detailed safety analyses of LOCAs. The results of the study are especially useful for verification of the hydraulic treatment of reactor core computer programs such as COBRA

  3. Postoperative Complications of Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Gastric Cancer in a Meta-Analysis of High-Quality Case-Controlled Studies

    Directory of Open Access Journals (Sweden)

    Mikito Inokuchi

    2016-01-01

    Full Text Available Background. Some meta-analyses of case-controlled studies (CCSs have shown that laparoscopic or laparoscopy-assisted total gastrectomy (LTG had some short-term advantages over open total gastrectomy (OTG. However, postoperative complications differed somewhat among the meta-analyses, and some CCSs included in the meta-analyses had mismatched factors between LTG and OTG. Methods. CCSs comparing postoperative complications between LTG and OTG were identified in PubMed and Embase. Studies matched for patients’ status, tumor stage, and the extents of lymph-node dissection were included. Outcomes of interest, such as anastomotic, other intra-abdominal, wound, and pulmonary complications, were evaluated in a meta-analysis performed using Review Manager version 5.3 software. Result. This meta-analysis included a total of 2,560 patients (LTG, 1,073 patients; OTG, 1,487 patients from 15 CCSs. Wound complications were significantly less frequent in LTG than in OTG (n = 2,430; odds ratio [OR] 0.30, 95% confidence interval [CI] 0.29–0.85, P=0.01, I2 = 0%, and OR 0.46, 95% CI 0.17–0.52, P<0.0001, I2 = 0%. However, the incidence of anastomotic complications was slightly but not significantly higher in LTG than in OTG (n = 2,560; OR 1.44, 95% CI 0.96–2.16, P=0.08, I2 = 0%. Conclusion. LTG was associated with a lower incidence of wound-related postoperative complications than was OTG in this meta-analysis of CCSs; however, some concern remains about anastomotic problems associated with LTG.

  4. Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

    Science.gov (United States)

    Fukuda, Yasunari; Yamamoto, Kazuyoshi; Hirao, Motohiro; Nishikawa, Kazuhiro; Nagatsuma, Yukiko; Nakayama, Tamaki; Tanikawa, Sugano; Maeda, Sakae; Uemura, Mamoru; Miyake, Masakazu; Hama, Naoki; Miyamoto, Atsushi; Ikeda, Masataka; Nakamori, Shoji; Sekimoto, Mitsugu; Fujitani, Kazumasa; Tsujinaka, Toshimasa

    2016-07-01

    Malignancy is a secondary cause of sarcopenia, which is associated with impaired cancer treatment outcomes. The aim of this study was to investigate the prevalence of preoperative sarcopenia among elderly gastric cancer patients undergoing gastrectomy and the differences in preoperative dietary intake and postoperative complications between sarcopenic and non-sarcopenic patients. Ninety-nine patients over 65 years of age who underwent gastrectomy for gastric cancer were analyzed. All patients underwent gait and handgrip strength testing, and whole-body skeletal muscle mass was measured using a bioimpedance analysis technique based on the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm for the evaluation of sarcopenia before surgery. Preoperative dietary intake was assessed using a food frequency questionnaire. Of these patients, 21 (21.2 %) were diagnosed with sarcopenia. Sarcopenic patients consumed fewer calories and less protein preoperatively (23.9 vs. 27.8 kcal/kg ideal weight/day and 0.86 vs. 1.04 g/kg ideal weight/day; P = 0.001 and 0.0005, respectively). Although the overall incidence of postoperative complications was similar in the two groups (57.1 % vs. 35.9 %; P = 0.08), the incidence of severe (Clavien-Dindo grade ≥ IIIa) complications was significantly higher in the sarcopenic group than in the non-sarcopenic group (28.6 % vs. 9.0 %; P = 0.029). In the multivariate analysis, sarcopenia alone was identified as a risk factor for severe postoperative complications (odds ratio, 4.76; 95 % confidence interval, 1.03-24.30; P = 0.046). Preoperative sarcopenia as defined by the EWGSOP algorithm is a risk factor for severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

  5. Self-Expandable Metal Stent for Closure of a Large Leak after Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    G. Curcio

    2010-08-01

    Full Text Available In recent years, self-expandable metallic stents (SEMSs have emerged as a promising treatment alternative for the bridging and sealing of esophageal perforations and extensive anastomotic leaks after esophageal resection or total gastrectomy. A 56-year-old woman underwent a total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy for a gastric signet ring cell carcinoma. Ten days later, esophagogastroduodenoscopy showed a 2 cm fistula in the distal end of the Roux limb of the anastomosis. This was confirmed by gastrografin esophagography. The patient was started on total parenteral nutrition. Having deemed clipping treatment for this fistula unfeasible, we decided to insert a partially silicone-coated SEMS (Evolution Controlled Release Esophageal Stent System, Cook Medical, Winston-Salem, N.C., USA. The stent was removed after ten days. Gastrografin esophagography showed no further contrast extravasation, and esophagogastroduodenoscopy showed closure of the fistula. No clinical complications were observed, and the patient was able to start normal per os nutrition. In conclusion, the treatment of symptomatic leaks in patients who have undergone esophagojejunostomy is challenging, and leakage from the jejunal stump can be a potentially serious complication. In the treatment of leakage after total gastrectomy, plastic stents (which are either too light or exercise too little radial force and totally covered metallic stents may not adhere sufficiently to the esophagojeujunal walls and, as a result, migrate beyond the anastomosis. The promising results of this report suggest that early stenting, using a partially silicone-coated SEMS, is a feasible alternative to surgical treatment in this category of patients.

  6. Studies on amino acid absorption and protein metabolism in the rat following total gastrectomy

    International Nuclear Information System (INIS)

    Walter, F.; Czarnetzki, H.D.; Albert, H.; Schwokowski, C.; Junghans, P.; Jung, K.; Akademie der Wissenschaften der DDR, Leipzig. Zentralinstitut fuer Isotopen- und Strahlenforschung)

    1982-01-01

    Rats were gastrectomized according to Graham and Longmire/Guetgemann, resp. 6 to 12 weeks after gastrectomy the animals received a single dose of 15 N-glycine with the food. 15 N excretion has been determined every 12 hours for 5 days. All rats revealed a positive N balance. Urinary excretion of 15 N was significantly less in rats operated according to Graham (missing duodenal passage) than in the controls and those operated according to Longmire. The differences seem to be caused by differently fast absorption, but the disturbances in the amino acid absorption are not aggravating and N balance and protein synthesis are normal

  7. Double-Acting Sleeve Muscle Actuator for Bio-Robotic Systems

    Directory of Open Access Journals (Sweden)

    Hao Zheng

    2013-11-01

    Full Text Available This paper presents a new type of muscle-like actuator, namely double-acting (DA sleeve muscle actuator, which is suitable for the actuation of biologically-inspired and biomedical robotic systems, especially those serving human-assistance purposes (prostheses, orthoses, etc.. Developed based on the traditional pneumatic muscle actuator, the new DA sleeve muscle incorporates a unique insert at the center. With the insert occupying the central portion of the internal volume, this new actuator enjoys multiple advantages relative to the traditional pneumatic muscle, including a consistent increase of force capacity over the entire range of motion, and a significant decrease of energy consumption in operation. Furthermore, the insert encompasses an additional chamber, which generates an extension force when pressurized. As such, this new actuator provides a unique bi-directional actuation capability, and, thus, has a potential to significantly simplify the design of a muscle actuator-powered robotic system. To demonstrate this new actuator concept, a prototype has been designed and fabricated, and experiments conducted on this prototype demonstrated the enhanced force capacity and the unique bi-directional actuation capability.

  8. Double-Acting Sleeve Muscle Actuator for Bio-Robotic Systems

    Science.gov (United States)

    Zheng, Hao; Shen, Xiangrong

    2014-01-01

    This paper presents a new type of muscle-like actuator, namely double-acting (DA) sleeve muscle actuator, which is suitable for the actuation of biologically-inspired and biomedical robotic systems, especially those serving human-assistance purposes (prostheses, orthoses, etc.). Developed based on the traditional pneumatic muscle actuator, the new DA sleeve muscle incorporates a unique insert at the center. With the insert occupying the central portion of the internal volume, this new actuator enjoys multiple advantages relative to the traditional pneumatic muscle, including a consistent increase of force capacity over the entire range of motion, and a significant decrease of energy consumption in operation. Furthermore, the insert encompasses an additional chamber, which generates an extension force when pressurized. As such, this new actuator provides a unique bi-directional actuation capability, and, thus, has a potential to significantly simplify the design of a muscle actuator-powered robotic system. To demonstrate this new actuator concept, a prototype has been designed and fabricated, and experiments conducted on this prototype demonstrated the enhanced force capacity and the unique bi-directional actuation capability. PMID:25264492

  9. Architecture and permeability of post-cytokinesis plasmodesmata lacking cytoplasmic sleeves.

    Science.gov (United States)

    Nicolas, William J; Grison, Magali S; Trépout, Sylvain; Gaston, Amélia; Fouché, Mathieu; Cordelières, Fabrice P; Oparka, Karl; Tilsner, Jens; Brocard, Lysiane; Bayer, Emmanuelle M

    2017-06-12

    Plasmodesmata are remarkable cellular machines responsible for the controlled exchange of proteins, small RNAs and signalling molecules between cells. They are lined by the plasma membrane (PM), contain a strand of tubular endoplasmic reticulum (ER), and the space between these two membranes is thought to control plasmodesmata permeability. Here, we have reconstructed plasmodesmata three-dimensional (3D) ultrastructure with an unprecedented level of 3D information using electron tomography. We show that within plasmodesmata, ER-PM contact sites undergo substantial remodelling events during cell differentiation. Instead of being open pores, post-cytokinesis plasmodesmata present such intimate ER-PM contact along the entire length of the pores that no intermembrane gap is visible. Later on, during cell expansion, the plasmodesmata pore widens and the two membranes separate, leaving a cytosolic sleeve spanned by tethers whose presence correlates with the appearance of the intermembrane gap. Surprisingly, the post-cytokinesis plasmodesmata allow diffusion of macromolecules despite the apparent lack of an open cytoplasmic sleeve, forcing the reassessment of the mechanisms that control plant cell-cell communication.

  10. Testing of a new prototype surgical stapler that automates the rollover sleeve technique for venous anastomoses

    Directory of Open Access Journals (Sweden)

    PATRICIA B CARROLL

    2006-01-01

    Full Text Available The creation of successful vascular anastomoses is of primary importance in many surgical fields. Numerous attempts to automate this process have been made. These techniques have slowly gained acceptance, but their use is still limited. This report details feasibility testing of a new prototype stapler that automates the rollover sleeve technique for venous vascular anastomoses. Male and female mongrel dogs (n=7 (25-32 kg were used. A segment of the right (n=5 or left (n=2 iliac vein was harvested for interposition grafts after the contra lateral side was transected. In each dog, two end-to-end venous anastomoses at the interposition grafts were performed. The standard anastomosis employed continuous mattress sutures. The experimental anastomosis was performed with a new prototype surgical stapler. The stapled anastomosis was proximal and the sutured was distal. In all experiments, it was possible to perform the experimental anastomosis with the stapler. Complications included two small leaks, one due to misfiring of a single pin in one experimental site. These leaks required suture reinforcement. One dog died of hemorrhage due to a slipped suture at the vein harvest site. One vein had thrombus seen at the sutured site although no technical abnormalities at either of the anastomoses could be found. After two weeks, grafts were inspected grossly and histologically. Healing appeared normal. There was a trend for less inflammatory cells infiltrating stapled sites; however, this was not statistically significant. The experiments demonstrate that this device can automate the rollover sleeve technique for venous anastomoses.

  11. Rotating-Sleeve Triboelectric-Electromagnetic Hybrid Nanogenerator for High Efficiency of Harvesting Mechanical Energy.

    Science.gov (United States)

    Cao, Ran; Zhou, Tao; Wang, Bin; Yin, Yingying; Yuan, Zuqing; Li, Congju; Wang, Zhong Lin

    2017-08-22

    Currently, a triboelectric nanogenerator (TENG) and an electromagnetic generator (EMG) have been hybridized to effectively scavenge mechanical energy. However, one critical issue of the hybrid device is the limited output power due to the mismatched output impedance between the two generators. In this work, impedance matching between the TENG and EMG is achieved facilely through commercial transformers, and we put forward a highly integrated hybrid device. The rotating-sleeve triboelectric-electromagnetic hybrid nanogenerator (RSHG) is designed by simulating the structure of a common EMG, which ensures a high efficiency in transferring ambient mechanical energy into electric power. The RSHG presents an excellent performance with a short-circuit current of 1 mA and open-circuit voltage of 48 V at a rotation speed of 250 rpm. Systematic measurements demonstrate that the hybrid nanogenerator can deliver the largest output power of 13 mW at a loading resistance of 8 kΩ. Moreover, it is demonstrated that a wind-driven RSHG can light dozens of light-emitting diodes and power an electric watch. The distinctive structure and high output performance promise the practical application of this rotating-sleeve structured hybrid nanogenerator for large-scale energy conversion.

  12. Double-Acting Sleeve Muscle Actuator for Bio-Robotic Systems.

    Science.gov (United States)

    Zheng, Hao; Shen, Xiangrong

    2013-11-25

    This paper presents a new type of muscle-like actuator, namely double-acting (DA) sleeve muscle actuator, which is suitable for the actuation of biologically-inspired and biomedical robotic systems, especially those serving human-assistance purposes (prostheses, orthoses, etc .). Developed based on the traditional pneumatic muscle actuator, the new DA sleeve muscle incorporates a unique insert at the center. With the insert occupying the central portion of the internal volume, this new actuator enjoys multiple advantages relative to the traditional pneumatic muscle, including a consistent increase of force capacity over the entire range of motion, and a significant decrease of energy consumption in operation. Furthermore, the insert encompasses an additional chamber, which generates an extension force when pressurized. As such, this new actuator provides a unique bi-directional actuation capability, and, thus, has a potential to significantly simplify the design of a muscle actuator-powered robotic system. To demonstrate this new actuator concept, a prototype has been designed and fabricated, and experiments conducted on this prototype demonstrated the enhanced force capacity and the unique bi-directional actuation capability.

  13. Testing of a new prototype surgical stapler that automates the rollover sleeve technique for venous anastomoses.

    Science.gov (United States)

    Carroll, Patricia B; Defaria, Werviston; Gandia, Carlos; Berho, Mariana; Misiakos, Evangelos; Tzakis, Andreas G

    2006-01-01

    The creation of successful vascular anastomoses is of primary importance in many surgical fields. Numerous attempts to automate this process have been made. These techniques have slowly gained acceptance, but their use is still limited. This report details feasibility testing of a new prototype stapler that automates the rollover sleeve technique for venous vascular anastomoses. Male and female mongrel dogs (n=7) (25-32 kg) were used. A segment of the right (n=5) or left (n=2) iliac vein was harvested for interposition grafts after the contra lateral side was transected. In each dog, two end-to-end venous anastomoses at the interposition grafts were performed. The standard anastomosis employed continuous mattress sutures. The experimental anastomosis was performed with a new prototype surgical stapler. The stapled anastomosis was proximal and the sutured was distal. In all experiments, it was possible to perform the experimental anastomosis with the stapler. Complications included two small leaks, one due to misfiring of a single pin in one experimental site. These leaks required suture reinforcement. One dog died of hemorrhage due to a slipped suture at the vein harvest site. One vein had thrombus seen at the sutured site although no technical abnormalities at either of the anastomoses could be found. After two weeks, grafts were inspected grossly and histologically. Healing appeared normal. There was a trend for less inflammatory cells infiltrating stapled sites; however, this was not statistically significant. The experiments demonstrate that this device can automate the rollover sleeve technique for venous anastomoses.

  14. Numerical Analysis and Experimental Study of Hard Roofs in Fully Mechanized Mining Faces under Sleeve Fracturing

    Directory of Open Access Journals (Sweden)

    Zhitao Zheng

    2015-11-01

    Full Text Available Sudden falls of large-area hard roofs in a mined area release a large amount of elastic energy, generate dynamic loads, and cause disasters such as impact ground pressure and gas outbursts. To address these problems, in this study, the sleeve fracturing method (SFM was applied to weaken a hard roof. The numerical simulation software FLAC3D was used to develop three models based on an analysis of the SFM working mechanism. These models were applied to an analysis of the fracturing effects of various factors such as the borehole diameter, hole spacing, and sleeve pressure. Finally, the results of a simulation were validated using experiments with similar models. Our research indicated the following: (1 The crack propagation directions in the models were affected by the maximum principal stress and hole spacing. When the borehole diameter was fixed, the fracturing pressure increased with increasing hole spacing. In contrast, when the fracturing pressure was fixed, the fracturing range increased with increasing borehole diameter; (2 The most ideal fracturing effect was found at a fracturing pressure of 17.6 MPa in the model with a borehole diameter of 40 mm and hole spacing of 400 mm. The results showed that it is possible to regulate the falls of hard roofs using the SFM. This research may provide a theoretical basis for controlling hard roofs in mining.

  15. Alternative design of pipe sleeve for liquid removal mechanism in mortar slab layer

    Science.gov (United States)

    Nazri, W. M. H. Wan; Anting, N.; Lim, A. J. M. S.; Prasetijo, J.; Shahidan, S.; Din, M. F. Md; Anuar, M. A. Mohd

    2017-11-01

    Porosity is one of the mortar’s characteristics that can cause problems, especially in the room space that used high amount of water, such as bathrooms. Waterproofing is one of the technology that normally used to minimize this problem which is preventing deep penetration of liquid water or moisture into underlying concrete layers. However, without the proper mechanism to remove liquid water and moisture from mortar system, waterproofing layer tends to be damaged after a long period of time by the static formation of liquid water and moisture at mortar layer. Thus, a solution has been proposed to drain out water that penetrated into the mortar layer. This paper introduces a new solution using a Modified Pipe Sleeve (MPS) that installed at the mortar layer. The MPS has been designed considering the percentage surface area of the pipe sleeve that having contact with mortar layer (2%, 4%, 6%, 8% and 10%) with angle of holes of 60°. Infiltration test and flow rate test have been conducted to identify the effectiveness of the MPS in order to drain out liquid water or moisture from the mortar layer. In this study shows that, MPS surface area 10%, angled 60°, function effectively as a water removal compared to other design.

  16. Behandling med duodenal-jejunal bypass-sleeve ved svær overvægt

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  17. Experimental and numerical study of steel pipe with part-wall defect reinforced with fibre glass sleeve

    International Nuclear Information System (INIS)

    Mazurkiewicz, Lukasz; Tomaszewski, Michal; Malachowski, Jerzy; Sybilski, Kamil; Chebakov, Mikhail; Witek, Maciej; Yukhymets, Peter; Dmitrienko, Roman

    2017-01-01

    The paper presents numerical and experimental burst pressure evaluation of the gas seamless hot-rolled steel pipe. The main goal was to estimate mechanical toughness of pipe wrapped with composite sleeve and verify selected sleeve thickness. The authors used a nonlinear explicit FE code with constitutive models which allows for steel and composite structure failure modelling. Thanks to the achieved numerical and analytical results it was possible to perform the comparison with data received from a capacity test and good correlation between the results were obtained. Additionally, the conducted analyses revealed that local reduction of pipe wall thickness from 6 mm to 2.4 mm due to corrosion defect can reduce high pressure resistance by about 40%. Finally, pipe repaired by a fibre glass sleeve with epoxy resin with 6 mm thickness turned out more resistant than an original steel pipe considering burst pressure. - Highlights: • Numerical and experimental burst pressure evaluation of steel pipe was performed. • Seamless hot-rolled steel pipe with and without corrosion defect were considered. • Local reduction of pipe wall thickness from 6 to 2.4 mm reduces resistance by 40%. • Pipe repaired by a 6 mm fibre glass sleeve was more resistant than an original pipe.

  18. Biological conduit small gap sleeve bridging method for peripheral nerve injury: regeneration law of nerve fibers in the conduit

    Directory of Open Access Journals (Sweden)

    Pei-xun Zhang

    2015-01-01

    Full Text Available The clinical effects of 2-mm small gap sleeve bridging of the biological conduit to repair peripheral nerve injury are better than in the traditional epineurium suture, so it is possible to replace the epineurium suture in the treatment of peripheral nerve injury. This study sought to identify the regeneration law of nerve fibers in the biological conduit. A nerve regeneration chamber was constructed in models of sciatic nerve injury using 2-mm small gap sleeve bridging of a biodegradable biological conduit. The results showed that the biological conduit had good histocompatibility. Tissue and cell apoptosis in the conduit apparently lessened, and regenerating nerve fibers were common. The degeneration regeneration law of Schwann cells and axons in the conduit was quite different from that in traditional epineurium suture. During the prime period for nerve fiber regeneration (2-8 weeks, the number of Schwann cells and nerve fibers was higher in both proximal and distal ends, and the effects of the small gap sleeve bridging method were better than those of the traditional epineurium suture. The above results provide an objective and reliable theoretical basis for the clinical application of the biological conduit small gap sleeve bridging method to repair peripheral nerve injury.

  19. The design, effectiveness and acceptability of the arm sleeve for the prevention of body fluid contamination during obstetric procedures.

    Science.gov (United States)

    Kabukoba, J J; Pearce, J M

    1993-08-01

    1. To design a device that would reduce contamination of staff during obstetric procedures. 2. To undertake clinical trials to assess the effectiveness and acceptability of such a device. A prospective study. The arm sleeve is made of a nonwoven material laminated on polyethylene film making it waterproof. It has an elastomeric cuff with adhesive that ensures a watertight seal between it and the glove. Delivery suite in a teaching hospital. Doctors and midwives were requested to wear the sleeve on top of the standard gown and gloves. Each user was assessed for blood contamination at the end of the procedure and a questionnaire detailing the extent of contamination and the views of the user was completed. Eighty questionnaires were completed. The contamination of arms and hands was 3.8% and 5%, respectively. Eighty-nine percent thought the sleeve had served its purpose and 76% said they would use it regularly. The sleeve is an effective protective device which complements the glove and gown. We recommend that it should be used during all obstetric procedures.

  20. Effect of Sleeve Plunge Depth on Microstructure and Mechanical Properties of Refill Friction Stir Spot Welding of 2198 Aluminum Alloy

    Science.gov (United States)

    Yue, Yumei; Shi, Yao; Ji, Shude; Wang, Yue; Li, Zhengwei

    2017-10-01

    Refill friction stir spot welding (RFSSW) is a new spot welding technology, by which spot joint without keyhole can be obtained. In this work, RFSSW was used to join 2-mm-thick 2198-T8 aluminum alloy sheets and effects of the sleeve plunge depth on microstructure and lap shear properties of the joints were mainly discussed. Results showed that when using small plunge depths of 2.4 and 2.6 mm, joints showed good formation and no defects were observed. Incomplete refilling defect was observed with increasing plunge depth due to material loss during welding. Size of the grains at sleeve-affected zone (SAZ) is smaller than that at the pin-affected zone, and the size becomes bigger with increasing the plunge depth. More secondary phase particles can be observed at SAZ with increasing the sleeve plunge depth. The lap shear failure load firstly increased and then decreased with increasing the sleeve plunge depth. The maximum failure load of 9819 N was attained with plug fracture mode when using 2.6 mm. Fracture morphologies show ductile fracture mode.

  1. Finite element analysis of a novel pin-sleeve system for external fixation of distal limb fractures in horses.

    Science.gov (United States)

    Brianza, Stefano; Brighenti, Vittoria; Lansdowne, Jennifer L; Schwieger, Karsten; Bouré, Ludovic

    2011-11-01

    The transfixation pin cast (TPC) is an external skeletal fixation technique used to treat horses with distal limb fractures, but its use is often associated with pin-loosening and an increased risk of treatment failure. To address implant loosening, the pin sleeve cast system (PSC) was recently designed and consists of a pin-sleeve unit inserted into the bone. Each pin runs through a sleeve placed in the bone, making contact at two fixed points only within the sleeve. Each pin is attached to a ring embedded in a resin cast. In this report, the mechanical performance of a traditional TPC pin arrangement was compared with that of the PSC using validated finite element models of bone substitutes previously tested in vitro. The PSC resulted in a marked reduction in peak strain magnitude around the pins and a more even distribution of strain across the bone cortex. The two systems resulted in comparable proximal fragment displacement and had a similar stress concentration around bone defects during implant removal. The findings suggest that the PSC load transfer mechanism is effective even in geometrically complex structures like equine bones. Copyright © 2010 Elsevier Ltd. All rights reserved.

  2. Composting municipal biosolids in polyethylene sleeves with forced aeration: Process control, air emissions, sanitary and agronomic aspects.

    Science.gov (United States)

    Avidov, R; Saadi, I; Krassnovsky, A; Hanan, A; Medina, Sh; Raviv, M; Chen, Y; Laor, Y

    2017-09-01

    Composting in polyethylene sleeves with forced aeration may minimize odor emissions, vectors attraction and leachates associated with open windrows. A disadvantage of this technology is the lack of mixing during composting, potentially leading to non-uniform products. In two pilot experiments using biosolids and green waste (1:1; v:v), thermophilic conditions (>45°C) were maintained for two months, with successful control of oxygen levels and sufficient moisture. Emitted odors declined from 1.5-3.8×10 5 to 5.9×10 3 -2.3×10 4 odor units m -3 -air in the first 3weeks of the process, emphasizing the need of odor control primarily during this period. Therefore, composting might be managed in two phases: (i) a closed sleeve for 6-8weeks during which the odor is treated; (ii) an open pile (odor control is not necessary). Reduction of salmonella, E. coli and coliforms was effective initially, meeting the standards of "Class A" biosolids; however, total and fecal coliforms density increased after opening the second sleeve and exceeded the standard of 1000 most probable number (MPN) per g dry matter. Compost maturity was achieved in the open piles following the two sleeves and the final compost was non-phytotoxic and beneficial as a soil additive. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Effects of daikenchuto, a Japanese herb, on intestinal motility after total gastrectomy: a prospective randomized trial.

    Science.gov (United States)

    Akamaru, Yusuke; Takahashi, Tsuyoshi; Nishida, Toshirou; Omori, Takeshi; Nishikawa, Kazuhiro; Mikata, Shoki; Yamamura, Noriyuki; Miyazaki, Satoru; Noro, Hiroshi; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

    2015-03-01

    This study aimed to assess the efficacy of daikenchuto (DKT), a commonly prescribed, traditional Japanese herbal medicine, on postoperative intestinal dysfunction after gastric cancer surgery. Patients with gastric cancer scheduled for a total gastrectomy were randomly assigned before surgery to receive either no treatment (n = 40; control group) or DKT (7.5 g/day, t.i.d.) for 3 months (n = 41) postoperatively. We examined gastrointestinal motility, stool attributes, the quantity of bowel gas, the quality of life, and the incidence of postoperative ileus. During the hospital stay, significant differences were observed between the DKT group and controls in the number of stools per day (1.1 ± 0.6 vs 0.8 ± 0.4, respectively; P = 0.037) and stool consistencies (Bristol scale ratings were 3.7 ± 0.8 vs 3.1 ± 0.8, respectively; P = 0.041). The DKT group showed significant reductions in gas volume scores, calculated from abdominal radiographs, at 7 days, 1 month, and 3 months after surgery. The groups did not show significant differences in quality of life scores (based on the Gastrointestinal Symptom Rating Scale) or in the incidence of postoperative ileus. DKT improved bowel movements, stool properties, and bowel gas. These results suggested that DKT promoted early postoperative bowel functions after total gastrectomy.

  4. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    Science.gov (United States)

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. [Terminolateral esophagojejunostomy after gastrectomy with the biofragmentable anastomosis ring in the dog model].

    Science.gov (United States)

    Dietz, U A; Araújo, A C F; Czeczko, N G; Lemos, R; Araújo, U; Inácio, C M; Salles, G; Corrêa Neto, M; Repka, J C D; Zanellato, C M F; Malafaia, O; Debus, E S; Thiede, A

    2005-06-01

    Esophagojejunostomy after total gastrectomy still remains a high risk anastomosis with a considerable morbidity and mortality. The majority of these anastomoses are performed by the intraluminal stapler technique, yet stenoses are a known late complication even after an uneventful postoperative course. In the present study, the osophagojejunostomy with the biofragmentable anastomosis ring (BAR) was examined in dogs. 28 dogs were randomized into a group of manual suture (n = 14) and a BAR-group (n = 14). After gastrectomy, the esophagojejunostomy was performed by hand-suture with polypropylene 4-0 in the manual suture group, and with the 25/1.5 mm BAR in the BAR-group. In both groups the Roux-en-Y jejunojejunostomy was performed by hand-suture. The dogs were evaluated on postoperative days 4, 7 and 14 with regard to macroscopy, bursting strength, tissue hydroxyproline and histology. There was one leakage without clinical effect in the hand-sewn group on postoperative day 4; there was no leak in the BAR-group. In observing fibre-free enteral feeding, neither functional disorders nor obstruction of the BAR were observed. The general anastomosis parameters were matchable between the groups. The infracarinal BAR-esophagojejunostomy is comparable to the hand-sewn anastomosis in the dog-model.

  6. Body composition analysis within 1 month after gastrectomy for gastric cancer.

    Science.gov (United States)

    Aoyama, Toru; Kawabe, Taiichi; Hirohito, Fujikawa; Hayashi, Tsutomu; Yamada, Takanobu; Tsuchida, Kazuhito; Sato, Tsutomu; Oshima, Takashi; Rino, Yasushi; Masuda, Munetaka; Ogata, Takashi; Cho, Haruhiko; Yoshikawa, Takaki

    2016-04-01

    A significant body weight loss (BWL) is observed during 1 month after gastrectomy for gastric cancer. However, it remains unclear which body component mainly accounts for the weight loss. Two-hundred forty-four patients who underwent gastrectomy for gastric cancer between May 2010 and October 2013 were examined. Body weight and composition were evaluated by a bioelectrical impedance analyzer within 1 week before surgery (first measurement), at 1 week after surgery (second measurement), and at 1 month after surgery (third measurement). The changes in the early period were defined as the differences until the second measurement, and those in the late period were defined as the differences from the second to the third measurement. Total BWL within 1 month was -3.4 kg, and the rate of body weight at 1 month to the preoperative body weight was 94.1 %. BWL was significantly greater in the early period than in the late period (-2.1 kg vs -1.2 kg, p body mass was significantly greater than loss of fat mass (-1.5 kg vs -0.6 kg, p body mass accounted for a significant part of the BWL during the first week.

  7. Feasibility and Nutritional Benefits of Laparoscopic Proximal Gastrectomy for Early Gastric Cancer in the Upper Stomach.

    Science.gov (United States)

    Kosuga, Toshiyuki; Ichikawa, Daisuke; Komatsu, Shuhei; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Otsuji, Eigo

    2015-12-01

    Laparoscopic proximal gastrectomy (LPG) has recently been applied for early gastric cancer (EGC) in the upper stomach as a minimally invasive and function-preserving surgery. This study aimed to clarify the feasibility and nutritional benefits of LPG over laparoscopic total gastrectomy (LTG). This was a retrospective study of 77 patients with clinical stage I gastric cancer in the upper stomach. Of these patients, 25 underwent LPG, while 52 underwent LTG. Surgical outcomes and postoperative nutritional status such as changes in body weight and blood chemistries were compared between LPG and LTG. Intraoperative blood loss and C-reactive protein levels at 3 and 7 days after surgery were significantly lower in LPG than in LTG (p = 0.018, 0.036, and 0.042, respectively). No significant differences were observed in postoperative early or late complication rates between LPG and LTG. The incidence of Los Angeles Grade B or more severe reflux esophagitis after LPG was 9.1 %, which was similar to that after LTG (9.3 %). Postoperative changes in body weight at 6 months and 1 and 2 years after surgery were consistently less in LPG than in LTG (p = 0.001, 0.022, and 0.001, respectively). Moreover, postoperative levels of hemoglobin and serum albumin and total lymphocyte count were also higher in LPG than in LTG. LPG may be a better choice for EGC in the upper stomach than LTG because it has distinct advantages in terms of surgical invasiveness and postoperative nutritional status.

  8. High prevalence of osteoporosis in patients with gastric adenocarcinoma following gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To evaluate the prevalence and predictive factors of osteoporosis in patients with gastric adenocarcinoma after gastrectomy.METHODS: The study included 133 patients diagnosed with gastric adenocarcinoma but who did not undergo prior diagnostic work-up for osteoporosis. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) and vertebral deformity was assessed by plain X-rays. We evaluated the effects of age, sex, body mass index (BMI), anemia, back pain,vertebral deformity, tumor staging, reconstruction type,and past medical history to determine predictive factors of osteoporosis in these patients.RESULTS: The prevalence of osteoporosis in the lumbar spine was 38.3% (male, 28.9%; female, 54.0%), and 15.0% in the femoral neck (male, 10.8%; female,22.0%). The vertebral deformity rate was 46.6% (male,43.4%; female, 52.0%). Age, BMI and hemoglobin correlated with BMD (P < 0.01). In males, anemia and age > 64 years were independent predictive factors of osteoporosis in multivariate analysis. In females, back pain was an independent factor for osteoporosis.CONCLUSION: The results of this study revealed that prevalence of osteoporosis and vertebral bone deformity rate were high in gastric cancer patients, regardless of post-gastrectomy duration and operation type. Early diagnosis and a proper management plan must be established in these patients.

  9. Randomized Controlled Trial to Evaluate Splenectomy in Total Gastrectomy for Proximal Gastric Carcinoma.

    Science.gov (United States)

    Sano, Takeshi; Sasako, Mitsuru; Mizusawa, Junki; Yamamoto, Seiichiro; Katai, Hitoshi; Yoshikawa, Takaki; Nashimoto, Atsushi; Ito, Seiji; Kaji, Masahide; Imamura, Hiroshi; Fukushima, Norimasa; Fujitani, Kazumasa

    2017-02-01

    To clarify the role of splenectomy in total gastrectomy for proximal gastric cancer. Splenectomy in total gastrectomy is associated with increased operative morbidity and mortality, but its survival benefit is unclear. Previous randomized controlled trials were underpowered and inconclusive. We conducted a multiinstitutional randomized controlled trial. Proximal gastric adenocarcinoma of T2-4/N0-2/M0 not invading the greater curvature was eligible. During the operation, surgeons confirmed that R0 resection was possible with negative lavage cytology, and patients were randomly assigned to either splenectomy or spleen preservation. The primary endpoint was overall survival (OS) and the secondary endpoints were relapse-free survival, operative morbidity, operation time, and blood loss. The trial was designed to confirm noninferiority of spleen preservation to splenectomy in OS with a noninferiority margin of the hazard ratio as 1.21 and 1-sided alpha of 5%. Between June 2002 and March 2009, 505 patients (254 splenectomy, 251 spleen preservation) were enrolled from 36 institutions. Splenectomy was associated with higher morbidity and larger blood loss, but the operation time was similar. The 5-year survivals were 75.1% and 76.4% in the splenectomy and spleen preservation groups, respectively. The hazard ratio was 0.88 (90.7%, confidence interval 0.67-1.16) (splenectomy should be avoided as it increases operative morbidity without improving survival.

  10. Calf Compression Sleeves Change Biomechanics but Not Performance and Physiological Responses in Trail Running

    Directory of Open Access Journals (Sweden)

    Hugo A. Kerhervé

    2017-04-01

    Full Text Available Introduction: The aim of this study was to determine whether calf compression sleeves (CS affects physiological and biomechanical parameters, exercise performance, and perceived sensations of muscle fatigue, pain and soreness during prolonged (~2 h 30 min outdoor trail running.Methods: Fourteen healthy trained males took part in a randomized, cross-over study consisting in two identical 24-km trail running sessions (each including one bout of running at constant rate on moderately flat terrain, and one period of all-out running on hilly terrain wearing either degressive CS (23 ± 2 mmHg or control sleeves (CON, <4 mmHg. Running time, heart rate and muscle oxygenation of the medial gastrocnemius muscle (measured using portable near-infrared spectroscopy were monitored continuously. Muscle functional capabilities (power, stiffness were determined using 20 s of maximal hopping before and after both sessions. Running biomechanics (kinematics, vertical and leg stiffness were determined at 12 km·h−1 at the beginning, during, and at the end of both sessions. Exercise-induced Achilles tendon pain and delayed onset calf muscles soreness (DOMS were assessed using visual analog scales.Results: Muscle oxygenation increased significantly in CS compared to CON at baseline and immediately after exercise (p < 0.05, without any difference in deoxygenation kinetics during the run, and without any significant change in run times. Wearing CS was associated with (i higher aerial time and leg stiffness in running at constant rate, (ii with lower ground contact time, higher leg stiffness, and higher vertical stiffness in all-out running, and (iii with lower ground contact time in hopping. Significant DOMS were induced in both CS and CON (>6 on a 10-cm scale with no difference between conditions. However, Achilles tendon pain was significantly lower after the trial in CS than CON (p < 0.05.Discussion: Calf compression did not modify muscle oxygenation during ~2 h 30

  11. Band structure of semiconductors

    CERN Document Server

    Tsidilkovski, I M

    2013-01-01

    Band Structure of Semiconductors provides a review of the theoretical and experimental methods of investigating band structure and an analysis of the results of the developments in this field. The book presents the problems, methods, and applications in the study of band structure. Topics on the computational methods of band structure; band structures of important semiconducting materials; behavior of an electron in a perturbed periodic field; effective masses and g-factors for the most commonly encountered band structures; and the treatment of cyclotron resonance, Shubnikov-de Haas oscillatio

  12. Long-term comparison of boomerang-shaped jejunal interposition and Billroth-I reconstruction after distal gastrectomy.

    Science.gov (United States)

    Sasaki, Kinro; Miyachi, Kazuhito; Yoda, Norihito; Onodera, Shinichi; Satomura, Hitoshi; Otsuka, Kichiro; Nakajima, Masanobu; Yamaguchi, Satoru; Sunagawa, Masakatsu; Kato, Hiroyuki

    2015-05-01

    Billroth-I (BI) is a simple, physiological method of reconstruction following distal gastrectomy. In actuality, postoperative QOL is by no means favorable due to the high incidence of post-gastrectomy syndrome. The aim of this study is to assess the safety and efficacy of boomerang-shaped jejunal interposition (BJI) after distal gastrectomy. Sixty-six patients with early gastric cancer underwent the BI procedure (n = 33) or BJI (n = 33) after distal gastrectomy, following which they were compared for 5 years. Tumor characteristics, operative details, postoperative complications and complaints, number of meals, and body weight were analyzed. Patients were followed up by endoscopy every 12 months. There were no significant differences in the incidence of postoperative complications. The incidence of heartburn (30 vs. 0 %, P = 0.0009) and oral bitterness (33 vs. 6 %, P = 0.0112) were significantly lower in the BJI cases. Endoscopic findings revealed significantly lower incidences of reflux esophagitis (24 vs. 0 %, P = 0.0051) and remnant gastritis (70 vs. 3 %, P < 0.0001) in the BJI group. The incidence of food stasis was low in both groups (12 vs. 15 %). In the BJI group, 30 patients (90 %) were eating 3 meals/day within 12 months, whereas in the BI group, 16 patients (48 %) were still eating 5 meals/day at 12 months or later. BJI is as safe as BI, but is better in terms of improvement in bile reflux and food intake without stasis. This procedure, therefore, appears to be a useful method for reconstruction after distal gastrectomy.

  13. Anorectal function following colo-anal sleeve anastomosis for chronic radiation injury to the rectum

    Energy Technology Data Exchange (ETDEWEB)

    Varma, J S; Smith, A N

    1986-04-01

    This paper reports the results of anorectal manometry and electrophysiological studies of the pelvic floor in eight patients who had undergone anterior resection of the rectum with mucosal proctectomy and colo-anal sleeve anastomosis for radiation rectal injury. The group comprised six women and two men (age range 61-84 years, mean 71 years). Six bladder carcinoma patients had received small field (10 x 10 cm) external beam radiotherapy (5500 cGy in 20 treatments over 4 weeks); two cervical cancer patients had been given whole pelvis, external beam radiotherapy supplemented by a single caesium implant (cumulative dosage of 9500 cGy to the vaginal vault, equivalent to 7500 cG to point A).

  14. Anorectal function following colo-anal sleeve anastomosis for chronic radiation injury to the rectum

    International Nuclear Information System (INIS)

    Varma, J.S.; Smith, A.N.

    1986-01-01

    This paper reports the results of anorectal manometry and electrophysiological studies of the pelvic floor in eight patients who had undergone anterior resection of the rectum with mucosal proctectomy and colo-anal sleeve anastomosis for radiation rectal injury. The group comprised six women and two men (age range 61-84 years, mean 71 years). Six bladder carcinoma patients had received small field (10 x 10 cm) external beam radiotherapy (5500 cGy in 20 treatments over 4 weeks); two cervical cancer patients had been given whole pelvis, external beam radiotherapy supplemented by a single caesium implant (cumulative dosage of 9500 cGy to the vaginal vault, equivalent to 7500 cG to point A). (UK)

  15. Air velocity profiles near sleeve blockages in an unheated 7 x 7 rod bundle. [PWR

    Energy Technology Data Exchange (ETDEWEB)

    Creer, J. M.; Bates, J. M.

    1979-04-01

    Local air velocity measurements were obtained with a laser Doppler anemometer near flow blockages in an unheated 7 x 7 rod bundle. Sleeve blockages were positioned on the center nine rods to create an area reduction of 90% in the center four subchannels of the bundle. Experimental results indicated that severe flow disturbances occurred downstream from the blockage cluster but showed only minor flow disturbances upstream from the blockage. Flow reversals were detected downstream from the blockage and persisted for approximately five subchannel hydraulic diameters. The air velocity profiles were in excellent agreement with water velocity data previously obtained at essentially the same Reynolds number. Subchannel average velocity predictions obtained with the COBRA computer program were in good agreement with subchannel average velocities estimated using the measured local velocity data.

  16. Design optimization of a robust sleeve antenna for hepatic microwave ablation

    International Nuclear Information System (INIS)

    Prakash, Punit; Webster, John G; Deng Geng; Converse, Mark C; Mahvi, David M; Ferris, Michael C

    2008-01-01

    We describe the application of a Bayesian variable-number sample-path (VNSP) optimization algorithm to yield a robust design for a floating sleeve antenna for hepatic microwave ablation. Finite element models are used to generate the electromagnetic (EM) field and thermal distribution in liver given a particular design. Dielectric properties of the tissue are assumed to vary within ± 10% of average properties to simulate the variation among individuals. The Bayesian VNSP algorithm yields an optimal design that is a 14.3% improvement over the original design and is more robust in terms of lesion size, shape and efficiency. Moreover, the Bayesian VNSP algorithm finds an optimal solution saving 68.2% simulation of the evaluations compared to the standard sample-path optimization method

  17. Analysis and application of GEWI sleeve weld-ability (Material: C45)

    International Nuclear Information System (INIS)

    Zhang Weiming; Zhang Hongliu

    2010-01-01

    Welding may use two kinds of welding process of shielded metal arc welding and CO 2 shielded arc welding between inner ring in nuclear island steel lining (material: P265GH) and GEWI sleeve (material:C45).CO 2 shielded arc welding is often used because of higher welding efficiency, in particular, in condition of plan press, but quality can come into being some problems if we lack strict measures, for example welding procedure. Shielded metal arc welding control easier quality, but welding efficiency is lower. Comparing and analyzing Weld-ability of C45(Medium carbon Quenched and Tempered Steel.) between of shielded metal arc welding and CO 2 shielded arc welding, suggest to use shielded metal arc welding in project practice, and control strict welding procedure measure of pre-heating treatment and Post-heating. (authors)

  18. Development of an eddy current inspection technique for sleeved engine disk bolt holes

    International Nuclear Information System (INIS)

    Palanisamy, R.; Lakin, K.M.

    1983-01-01

    Recent research programs have concentrated mainly on developing techniques to characterize surface breaking cracks and very little has been done towards characterizing subsurface flaws in conducting materials. Presented in this paper are the results of some initial theoretical work aimed at the development of a reliable eddy current technique to detect and characterize defects in engine disk bolt holes under a 0.05'' stainless steel sleeve. The change in impedance of an absolute eddy current coil with and without ferrite core, and the distribution of eddy currents around a second layer crack with and without a thin insulating film between the two conducting layers have been predicted numerically. The overall system development goals and methods to accomplish them are outlined briefly

  19. Surgical Results of Laparoscopic Loop Duodenojejunal Bypass with Sleeve Gastrectomy (LDJB-SG in Obese Asians (BMI ≥ 27.5 kg/m2 with Type 2 Diabetes Mellitus (T2DM: A New Promising Bariatric and Metabolic Surgery

    Directory of Open Access Journals (Sweden)

    Voraboot Taweerutchana, M.D. F.R.C.S.T.

    2018-03-01

    Full Text Available Objective: To demonstrate surgical outcomes, safety and complications in obese Asians (BMI > 27.5 kg/m2 who underwent LDJB-SG in our center. Methods: We retrospectively reviewed ninety-one patients who underwent LDJB-SG from October 2011 to March 2014. One-year surgical outcomes regarding the efficacy of weight loss, safety as well as complications of this procedure were demonstrated. Remission of T2DM and co-morbidities resolution after one year were also analyzed. Results: The median duration of T2DM was 60 months and the median operative time was 140 min. Interestingly, the mean/median preoperative BMI, HbA1C and FPG levels dropped significantly from 30.7 kg/m2 , 8.9%, and 139.0 mg% to 23.7 kg/m2 , 6.2%, and 95.0 mg% respectively at 1 year after operation (p<0.001. Furthermore, 61.5% of patients who had completed 1 year follow-up showed complete diabetic remission and 92.3% experienced glycemic control (HbA1c<7% without any medication. The postoperative complications were intra-abdominal bleeding (4.4%, leakage (1.1%, stricture (3.3% and port site hernia (2.2%. Conclusion: LDJB-SG is a safe and feasible bariatric and metabolic surgery, which has demonstrated excellent outcomes in terms of weight reduction, co-morbidities resolution as well as glycemic control in short-term follow-up.

  20. Sleeve gastrectomy to treat concomitant polycystyc ovary syndrome, insulin and leptin resistance in a 27-years morbidly obese woman unresponsive to insulin-sensitizing drugs: A 3-year follow-up

    Directory of Open Access Journals (Sweden)

    Luigi Schiavo

    2015-01-01

    Conclusion: In the present report, SG was applied to resolve an intricate endocrinological framework confirming its therapeutic value not only in determining weight loss but also as endocrine/metabolic surgery able to treat multifactorial endocrinopathy. The underlying molecular mechanisms contributing to these benefits remain largely undetermined, despite offering tremendous potential to reveal new targets for therapeutic intervention, mostly in those patients unresponsive to classical pharmacotherapy.

  1. [Total gastrectomy for gastric cancer: can the type of lymphadenectomy condition the long-term results?].

    Science.gov (United States)

    Di Martino, N; Izzo, G; Cosenza, A; Vicenzo, L; Monaco, L; Torelli, F; Basciotti, A; Brillantino, A; Marra, A

    2005-01-01

    Gastric cancer is the second tumor for frequency in the world. Surgery is still the only curative treatment. Good results in terms of long distance survival, postoperative morbidity and mortality have been achieved in the last years. The extension of lymphadenectomy is an important and discussed matter and it is not clear if lymphadenectomy may contribute to improve the surgical results. The Japanese surgeons were the first ones, in the 60's, to introduce a D2-D3 extended lymphadenectomy, but the real benefits of this technique are still being discussed. Indeed lymphonodal metastasis seem to be one of the most important prognostic factors in the gastric cancer and the level and the number of metastatic nodes are useful to predict the patients' survival. The aim of this study is to value the D2 lymphadenectomy in the patients who were treated with total gastrectomy for gastric adenocarcinoma, comparing the results both with the D1 lymphadenectomy and the D3-D4, paying attention to the survival rates related with the lymphonodal dissection. From 1998 to 2004, we studied 87 patients with gastric cancer. Out of 78 patients treated surgically, 9 were judged unresectable. Out of 69 patients treated surgically, one died before surgery and so he was put away by this study. All the patients were treated with total gastrectomy and a GI tract reconstruction by Roux's Y termino-lateral esophageal-jejunal anastomosis. In 20 patients we also made a splenectomy. We followed the Japanese Research Society for Gastric Cancer guidelines, according to which nodes are gathered into 16 levels and divided in 4 groups (N1-N4) depending on the cancer localization. The extension of the lymphadenectomy has been classified according to the level of the removed nods. The patients were divided into 3 groups. First group: patients undergone a total gastrectomy with D1 lymphadenectomy. Second group: patients undergone D2 lymphadenectomy. Third group: patients undergone D3 and D4 lymphadenectomy

  2. Extracellular space, blood volume, and the early dumping syndrome after total gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Miholic, J.; Reilmann, L.; Meyer, H.J.; Koerber, H.K.; Kotzerke, J.; Hecker, H. (Medzinische Hochschule Hannover (Germany, F.R.))

    1990-10-01

    Extracellular space and blood volume were measured using 82Br dilution and 51Cr-tagged erythrocytes in 24 tumor-free patients after total gastrectomy. Eleven of the patients suffered from early dumping. Age, blood volume, and extracellular space were significantly smaller in dumpers (P less than 0.05). The dumping score could be predicted by a multiple regression model considering blood volume per lean body mass and extracellular space (r = 0.637; P = 0.0039). Rapid (t1/2 less than 360 seconds) emptying of the gastric substitute, assessed using a 99Tc-labeled solid test meal, was significantly associated with dumping in addition to extracellular space and blood volume (r = 0.876; P = 0.0018). Both rapid emptying and a narrow extracellular space seem to contribute to the early dumping syndrome.

  3. Cardiopulmonary measurements in dogs undergoing gastropexy without gastrectomy for correction of gastric dilatation-volvulus.

    Science.gov (United States)

    Wagner, A E; Dunlop, C I; Chapman, P L

    1999-08-15

    To measure cardiopulmonary variables, including cardiac index, in dogs with naturally acquired gastric dilatation-volvulus (GDV). Prospective clinical study. 6 dogs with GDV. In addition to typical medical and surgical management of GDV, the dorsal metatarsal and pulmonary arteries and right atrium of the dogs were catheterized to obtain cardiopulmonary measurements before and during anesthesia and surgery. All dogs underwent gastropexy but none required gastrectomy. Mean cardiac index and mean arterial blood pressure for this small population of dogs with GDV were not significantly different from those reported for clinically normal awake or anesthetized dogs. Dogs with naturally acquired GDV without gastric necrosis may not have the classic characteristics, including decreased cardiac index and hypotension, of hypovolemic circulatory shock.

  4. Esophagojejunal Anastomosis Fistula, Distal Esophageal Stenosis, and Metalic Stent Migration after Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Nadim Al Hajjar

    2015-01-01

    Full Text Available Esophagojejunal anastomosis fistula is the main complication after a total gastrectomy. To avoid a complex procedure on friable inflamed perianastomotic tissues, a coated self-expandable stent is mounted at the site of the anastomotic leak. A complication of stenting procedure is that it might lead to distal esophageal stenosis. However, another frequently encountered complication of stenting is stent migration, which is treated nonsurgically. When the migrated stent creates life threatening complications, surgical removal is indicated. We present a case of a 67-year-old male patient who was treated at our facility for a gastric adenocarcinoma which developed, postoperatively, an esophagojejunostomy fistula, a distal esophageal stenosis, and a metallic coated self-expandable stent migration. To our knowledge, this is the first reported case of an esophagojejunostomy fistula combined with a distal esophageal stenosis as well as with a metallic coated self-expandable stent migration.

  5. Evaluation of the recurrence pattern of gastric cancer after laparoscopic gastrectomy with D2 lymphadenectomy.

    Science.gov (United States)

    Kawamura, Yuichiro; Satoh, Seiji; Umeki, Yusuke; Ishida, Yoshinori; Suda, Koichi; Uyama, Ichiro

    2016-01-01

    The aim of this study was to analyze the oncological aspects of gastric cancer following laparoscopic gastrectomy with D2 lymphadenectomy (LG-D2). We retrospectively evaluated the long-term outcomes of 354 patients who underwent LG-D2 for primary gastric cancer. Recurrence patterns and predictors of peritoneal metastasis were analyzed. Median follow-up time was 43.8 months. Five-year overall survival rates for yp/pStages I, II, and III gastric cancer were 93.7, 78.5, and 42.2 %, respectively. Recurrence was observed in 86 patients. Peritoneal metastasis was the most frequent recurrence pattern (n = 51), followed by hepatic metastasis (n = 17). Lymphatic recurrence at distant sites was observed in 10 patients. No locoregional lymph node metastasis or local recurrence was seen. Nine of 51 cases of peritoneal recurrence were detected by probe laparoscopy. Peritoneal recurrence rates were significantly higher in yp/pT4 and yp/pN3 diseases compared with yp/pT ≤ 3 and yp/pN ≤ 2 diseases. Multivariate analyses demonstrated that yp/pT4, yp/pN3, tumor size ≥70 mm, vascular invasion, and undifferentiated tumors were predictors of peritoneal recurrence following LG-D2. Long-term outcomes of gastric cancer following LG-D2, including recurrence patterns and predictors of peritoneal metastasis, were comparable to those following open D2 gastrectomy. LG-D2 showed good local control. Probe laparoscopy after LG may be effective in detecting peritoneal recurrence, which is not determined with less invasive examinations, including a CT scan. Future large-scale prospective studies are desirable to evaluate not only surgical but also oncological benefits and safety of LG-D2 for advanced gastric cancer.

  6. Ex-vivo release of Pipeline Embolization Device polytetrafluoroethylene (PTFE) sleeves for improved distal landing zone accuracy in-vivo: A technical note.

    Science.gov (United States)

    Griessenauer, Christoph J; Gupta, Raghav; Moore, Justin; Thomas, Ajith J; Ogilvy, Christopher S

    2016-12-01

    Distal landing zone accuracy is critical in some intracranial aneurysms treated with the Pipeline Embolization Device (PED), and delayed opening of the distal end of the device can complicate the procedure. Here, we report a technical nuance that facilitates accurate placement of the distal end of the PED by ex-vivo, pre-implantation release of the PED Flex polytetrafluoroethylene (PTFE) sleeves. The PED Flex is partially pushed out of the introducer sheath ex-vivo, pre-implantation until the distal PED opens entirely and the PTFE sleeves are located distal to the device. Without inverting the PTFE sleeves, the PED is carefully pulled back into the introducer sheath placing the PTFE sleeves inside the device. The PED is loaded into the microcatheter and advanced toward the site of implantation. When the PED is initially deployed and pushed out of the microcatheter, it opens immediately and provides an anchor for the remainder of the deployment process. We present a video (supplementary material) that illustrates the technique along with an illustrative case. Ex-vivo, pre-implantation release of the PTFE sleeves is an option in aneurysm treatment where distal landing accuracy is critical. Even without the protection of the PTFE sleeves, our clinical observation shows that the PED can be advanced safely through the microcatheter in selected cases. © The Author(s) 2016.

  7. Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres: multiple amplification of axonal regeneration

    OpenAIRE

    Yu-hui Kou; Pei-xun Zhang; Yan-hua Wang; Bo Chen; Na Han; Feng Xue; Hong-bo Zhang; Xiao-feng Yin; Bao-guo Jiang

    2015-01-01

    Multiple-bud regeneration, i.e., multiple amplification, has been shown to exist in peripheral nerve regeneration. Multiple buds grow towards the distal nerve stump during proximal nerve fiber regeneration. Our previous studies have verified the limit and validity of multiple amplification of peripheral nerve regeneration using small gap sleeve bridging of small donor nerves to repair large receptor nerves in rodents. The present study sought to observe multiple amplification of myelinated ne...

  8. Late onset of chylous ascites following distal gastrectomy with D1(+ dissection for gastric cancer: A case report

    Directory of Open Access Journals (Sweden)

    Hüseyin Çiyiltepe

    2015-12-01

    Full Text Available Chyloperitoneum is the accumulation of lymphatic fluid in the peritoneal cavity. Chylous ascites can occur if it is not recognized during surgery. The incidence of chylous ascites after oncological surgery was approximately 7.4% however, the incidence of lymphorrhea after radical gastrectomy for gastric cancer is so low. Extensive lymph node dissection leads to a higher incidence of lymphorrhea. There have been few cases associated with D1 dissection In most patients conservative treatment is recommended that includes paracentesis, total parenteral nutrition (TPN, a medium chain triglyceride (MCT based diet, and somatostatin. Surgery is the last choice only when conservative treatment fails. In this case we aimed to present a late onset of chylous ascites after subtotal gastrectomy and D1+ dissection that was treated with percutaneous drainage and conservative management.

  9. Percutaneous placement of self-expandable metallic stents in patients with obstructive janudice secondary to metastalic gastric cancer after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Seo, In Ho; Yu, Jung Rim; Mok, Young Jae; Oh, Joo Hyeong [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kwon, Se Hwan [Dept. of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Kim, Sam Soo [Dept. of Radiology, Kangwon National University College of Medicine, Chuncheon (Korea, Republic of); Kim, Seung Kwon [Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis (United States)

    2013-10-15

    To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

  10. Prolonged Hypocalcemia Following a Single Dose of Denosumab for Diffuse Bone Metastasis of Gastric Cancer after Total Gastrectomy.

    Science.gov (United States)

    Iizumi, Sakura; Shimoi, Tatsunori; Nishikawa, Tadaaki; Kitano, Atsuko; Sasada, Shinsuke; Shimomura, Akihiko; Noguchi, Emi; Yunokawa, Mayu; Yonemori, Kan; Shimizu, Chikako; Fujiwara, Yasuhiro; Tamura, Kenji

    2017-11-01

    Hypocalcemia is a significant adverse effect of denosumab. We herein report a case of prolonged hypocalcemia in a patient with multiple risk factors for hypocalcemia, including gastrectomy, increased bone turnover, and a poor performance status. Hypocalcemia developed after denosumab treatment for diffuse bone metastasis of gastric cancer, despite oral supplementation with vitamin D and calcium. To avoid serious prolonged hypocalcemia, a thorough assessment of the bone calcium metabolism is required before initiating denosumab treatment.

  11. Efficacy of Long-Term Oral Vitamin B12 Supplementation after Total Gastrectomy: Results from a Prospective Study

    Directory of Open Access Journals (Sweden)

    Joana Moleiro

    2017-11-01

    Full Text Available Background/Objectives: Vitamin B12 (VB12 deficiency is a common complication after total gastrectomy which may be associated with megaloblastic anemia and potentially irreversible neurologic symptoms. Intramuscular supplementation of VB12 has been considered the standard treatment, although it is associated with high costs and patient discomfort. Patients/Methods: We performed a prospective uncontrolled study (ACTRN12614000107628 in order to evaluate the clinical and laboratory efficacy of long-term oral VB12 supplementation in patients submitted to total gastrectomy. All patients received daily oral VB12 (1 mg/day and were evaluated every 3 months (clinical and laboratory evaluation: hemoglobin, VB12, total iron, ferritin, and folate. Results: A total of 26 patients were included with a mean age of 64 years (29-79. Patients were included with a mean period of 65 months (3-309 after total gastrectomy. At inclusion time, 17/26 patients were under intramuscular VB12, and 9 had not started supplementation yet. There were normal serum VB12 levels in 25/26 patients (mean VB12 serum levels: 657 pg/mL. The mean follow-up period was 20 (8.5-28 months. During follow-up, all patients had normal VB12 levels and there was no need for intramuscular supplementation. The patient with low VB12 levels had an increase to adequate levels, which remained stable. There were no differences with statistical significance among VB12 levels at 6 (867 pg/mL, 12 (1,008 pg/mL, 18 (1,018 pg/mL, and 24 (1,061 pg/mL months. Iron and folate supplementation was necessary in 21 and 7 patients, respectively. Conclusions: Oral VB12 supplementation is effective and safe in patients who underwent total gastrectomy and should be considered the preferential form of supplementation.

  12. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis

    OpenAIRE

    Cheng, Ying; Zhang, Junfeng; Zhang, Liwei; Wu, Juan; Zhan, Zhen

    2018-01-01

    Background Nutrition support is a common means for patients with gastric cancer, especially for those undergoing elective surgery. Recently, enteral immunonutrition (EIN) was increasingly found to be more effective than enteral nutrition (EN) in enhancing the host immunity and eventually improving the prognosis of gastric cancer patients undergoing gastrectomy. However, the results reported were not consistent. This meta-analysis aimed to assess the impact of EIN for patients with GC on bioch...

  13. Wide Band to ''Double Band'' upgrade

    International Nuclear Information System (INIS)

    Kasper, P.; Currier, R.; Garbincius, P.; Butler, J.

    1988-06-01

    The Wide Band beam currently uses electrons obtained from secondary photon conversions to produce the photon beam incident on the experimental targets. By transporting the positrons produced in these conversions as well as the electrons it is possible to almost double the number of photons delivered to the experiments per primary beam proton. 11 figs

  14. Combined acupuncture and general anesthesia on immune and cognitive function in elderly patients following subtotal gastrectomy for gastric cancer.

    Science.gov (United States)

    Wang, Ningke; Ou, Yangwen; Qing, Wenxiang

    2018-01-01

    This study investigated the effects of acupuncture combined with general anesthesia on postoperative immune and cognitive functions in elderly patients undergoing subtotal gastrectomy. We recruited 96 elderly patients who received anesthesia for subtotal gastrectomy and randomly divided them into control (n=48) and experimental (n=48) groups. The control group received general anesthesia and the experimental group received combined acupuncture and general anesthesia. We measured hemodynamic immediately before and after anesthesia induction, and immune observations before and after surgery. We found no significant differences in mean heart rate (HR), mean oxygen saturation (SpO2), and partial pressure of end-tidal carbon dioxide (PETCO2) in the perioperative period between the two groups. Mean arterial pressure (MAP) was lower in the experimental group than that in the control group (P0.05), but the incidence of delayed recovery and postoperative agitation were significantly lower in the experimental group compared with those in the control group (P<0.05). One day after surgery, the experimental group showed better protection of cognitive function than the control group (P<0.05). Overall, combined acupuncture and general anesthesia in elderly gastric cancer patients receiving subtotal gastrectomy showed more stable hemodynamics and fewer stress responses during surgery. Thus, combined acupuncture and general anesthesia can shorten the recovery time from anesthesia, have less negative effects on immune function and decrease the incidence of postoperative cognitive impairment.

  15. Clinical application of immune-enhanced enteral nutrition in patients with advanced gastric cancer after total gastrectomy.

    Science.gov (United States)

    Liu, Hua; Ling, Wei; Shen, Zhi Yong; Jin, Xin; Cao, Hui

    2012-08-01

    To determine whether immune-enhanced enteral nutrition (EN) was effective on nutritional status, immune function, surgical outcomes and days of hospitalization after total gastrectomy for patients with advanced gastric cancer (AGC). From August 2005 to May 2011, 78 patients with AGC who underwent a total gastrectomy were enrolled and divided randomly into three groups: immune-enhanced EN (EN + glutamine [Gln]) group, standard EN group and control group. Serum parameters including total protein, albumin, proalbumin and transferrin were examined on preoperative day 1, postoperative day 2 and day 12. Levels of immunoglobulin M (IgM), immunoglobulin G (IgG), natural killer (NK) cells, CD4⁺ and CD8⁺ T cells were also compared. The formulas were tolerated well in all the patients except 5 with mild complications. The EN + Gln and EN groups showed a faster onset of flatus and shorter hospitalization duration than the control group. On postoperative day 12, serum total protein, albumin, proalbumin and transferrin levels of the EN + Gln and EN groups were significantly higher than those of the control group (P nutritional status and immune function for the patients with AGC after total gastrectomy. © 2012 The Authors. Journal of Digestive Diseases © 2012 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.

  16. Implementation and Effectiveness of Early Chest Tube Removal during an Enhanced Recovery Programme after Oesophago-gastrectomy

    Directory of Open Access Journals (Sweden)

    Rajeev Bhandari

    2015-03-01

    Full Text Available Introduction: Oesophageal resection were notoriously complicated and produces a cohort of patients prone to postoperative complications and here we would like to focus on the implementation and effectiveness of early chest tube removal in ERAS after oesophago-gastrectomy considering the various aspect like pleural effusion and reducing the length of hospital stay which ultimately lead to reducing the economic burden on patient. Methods: An ERAS programme was devised and implemented with the support of a dedicated in-hospital task-force. The patients underwent esophago-gastrectomy were randomly divided into two groups: the ERAS group and the control group (non-ERAS. The ERAS group was treated with early removal of the chest tube after surgery, and the control group was treated with traditional way and outcomes were compared between them. Results: The length of hospital stay and the cost of hospitalization in the ERAS group were significantly lower than those in the control group(p<0.05. However, there was no statistical significant difference in the incidences of pleural effusion between the two groups(p>0.05. Conclusions: The introduction of early chest tube removal as an ERAS programme after oesophago-gastrectomy would not increase the risk of pleural effusion and would not increase the total length of stay and cost of hospitalisation without jeopardising patient safety or clinical outcomes.

  17. Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics

    International Nuclear Information System (INIS)

    Shinoto, Koichi; Ochiai, Takenori; Suzuki, Takao; Okazumi, Shin-ichi; Ozaki, Masahiko

    2003-01-01

    To evaluate the efficiency of Roux-en-Y reconstruction (RY) after distal gastrectomy we compared postoperative physiological functions and disorders among patients who underwent RY, conventional Billroth I reconstruction (BI), or Billroth II reconstruction (BII). The subjects were 91 patients who had undergone distal gastrectomy for gastric cancer more than 1 month earlier. To examine the severity of gastroesophageal reflux, acid reflux and alkali reflux were assessed, and to examine the severity of duodenal reflux into the remnant stomach, biliary scintigraphy was performed. The degree of inflammation in the esophagus and remnant stomach was examined by endoscopy. Questionnaires on postoperative complaints were sent out to the patients to determine how serious their reflux symptoms were. Both acid and alkali reflux were mild in the RY group. Biliary reflux into the remnant stomach, as assessed by biliary scintigraphy, was significantly less severe in the RY group than in the BI and BII groups. Endoscopy showed that inflammation of the lower esophagus and remnant stomach was much less severe in the RY group than in the BI and BII groups. According to the questionnaire survey, none of the patients in the RY group reported any reflux symptoms. In this series, RY was found to be a superior reconstruction method after distal gastrectomy since it was rarely accompanied by the reflux of duodenal juice into the remnant stomach or gastric reflux into the lower esophagus. (author)

  18. Body composition changes after totally laparoscopic distal gastrectomy with delta-shaped anastomosis: a comparison with conventional Billroth I anastomosis.

    Science.gov (United States)

    Park, Ki Bum; Kwon, Oh Kyoung; Yu, Wansik; Jang, Byeong-Churl

    2016-10-01

    The purpose of this study was to compare body composition changes of patients undergoing totally laparoscopic distal gastrectomy (TLDG) with delta-shaped anastomosis (DSA) versus conventional laparoscopic distal gastrectomy (CLDG). Data from gastric cancer patients who underwent laparoscopic distal gastrectomy for histologically proven gastric cancer in KNUMC from January 2013 to May 2014 were collected and reviewed. We examined 85 consecutive patients undergoing TLDG or CLDG: 41 patients underwent TLDG and 44 patients underwent CLDG. Body composition was assessed by segmental multifrequency bioelectrical impedance analysis. We compared the changes in nutritional parameters and body composition from preoperative status between the two groups at postoperative 6 and 12 months. All of the postoperative changes in the body composition and nutritional indices were similar between the two groups with the exception of visceral fat areas (VFAs) and albumin levels. VFAs increased at 6 months postoperatively in the TLDG group and a significant difference was shown at 12 months postoperatively between the TLDG and CLDG groups (86.7 ± 22.8 and 74.7 ± 21.9 cm(2), respectively, P body composition seemed comparable to those of CLDG. Six months postoperatively, VFAs and albumin levels were recovered in the TLDG group but not in the CLDG group. Thus, TLDG seems to be a novel surgical method.

  19. Single-incision laparoscopic distal gastrectomy for early gastric cancer through a homemade single port access device.

    Science.gov (United States)

    Jiang, Zhi-Wei; Zhang, Shu; Wang, Gang; Zhao, Kun; Liu, Jiang; Ning, Li; Li, Jieshou

    2015-01-01

    We presented a series of single-incision laparoscopic distal gastrectomies for early gastric cancer patients through a type of homemade single port access device and some other conventional laparoscopic instruments. A single-incision laparoscopic distal gastrectomy with D1 + α lymph node dissection was performed on a 46 years old male patient who had an early gastric cancer. This single port access device has facilitated the conventional laparoscopic instruments to accomplish the surgery and we made in only 6 minutes. Total operating time for this surgery was 240 minutes. During the operation, there were about 100 milliliters of blood loss, and 17 lymph-nodes were retrieved. This homemade single port access device shows its superiority in economy and convenience for complex single-incision surgeries. Single-incision laparoscopic distal gastrectomy for early gastric cancer can be conducted by experienced laparoscopic surgeons. Fully take advantage of both SILS and fast track surgery plan can bring to successful surgeries with minimal postoperative pain, quicker mobilization, early recovery of intestinal function, and better cosmesis effect for the patients.

  20. Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics

    Energy Technology Data Exchange (ETDEWEB)

    Shinoto, Koichi; Ochiai, Takenori; Suzuki, Takao; Okazumi, Shin-ichi; Ozaki, Masahiko [Chiba Univ. (Japan). School of Medicine

    2003-03-01

    To evaluate the efficiency of Roux-en-Y reconstruction (RY) after distal gastrectomy we compared postoperative physiological functions and disorders among patients who underwent RY, conventional Billroth I reconstruction (BI), or Billroth II reconstruction (BII). The subjects were 91 patients who had undergone distal gastrectomy for gastric cancer more than 1 month earlier. To examine the severity of gastroesophageal reflux, acid reflux and alkali reflux were assessed, and to examine the severity of duodenal reflux into the remnant stomach, biliary scintigraphy was performed. The degree of inflammation in the esophagus and remnant stomach was examined by endoscopy. Questionnaires on postoperative complaints were sent out to the patients to determine how serious their reflux symptoms were. Both acid and alkali reflux were mild in the RY group. Biliary reflux into the remnant stomach, as assessed by biliary scintigraphy, was significantly less severe in the RY group than in the BI and BII groups. Endoscopy showed that inflammation of the lower esophagus and remnant stomach was much less severe in the RY group than in the BI and BII groups. According to the questionnaire survey, none of the patients in the RY group reported any reflux symptoms. In this series, RY was found to be a superior reconstruction method after distal gastrectomy since it was rarely accompanied by the reflux of duodenal juice into the remnant stomach or gastric reflux into the lower esophagus. (author)

  1. [Application of subserosal injection of carbon nanoparticles via infusion needle to label lymph nodes in laparoscopic radical gastrectomy].

    Science.gov (United States)

    Chen, Hongyuan; Wang, Yanan; Xue, Fangqin; Yu, Jiang; Hu, Yanfeng; Liu, Hao; Yan, Jun; Li, Guoxin

    2014-05-01

    To explore the feasibility of subserosal injection of carbon nanoparticle via venous infusion needle to label lymph node and its application value in laparoscopic radical gastrectomy. Forty patients with gastric cancer were randomly divided into two groups (carbon nanoparticle group and control group). Subserosal injection of carbon nanoparticle around the tumor was performed via venous infusion needle laparoscopically at the beginning of surgery in carbon nanoparticles group, while the patients routinely underwent laparoscopic radical gastrectomy in control group. Results of harvested lymph nodes were compared between the two groups. The perioperative complications and the side effect of carbon nanoparticle were also evaluated. The average number of harvested lymph node in carbon nanoparticle group (31.7±7.6) was significantly higher than that in control group (19.8±6.1, Pinjection of carbon nanoparticle via venous infusion needle to label lymph nodes during laparoscopic radical gastrectomy is safe and feasible. It can increase the number of harvested lymph node, especially the small node.

  2. Sugammadex versus two doses of neostigmine for reversal of rocuronium in gastric sleeve surgery

    Directory of Open Access Journals (Sweden)

    Abdulhamid Alsaeed

    2017-01-01

    Patients and Methods: A total of 110 patients with body mass index> 40 underwent elective gastric sleeve surgery were enrolled in this study. Exclusion criteria included patients with co-existing muscular and cardiovascular diseases. Patients were randomly allocated to one of the following groups: group A (SUG, Group B (NEO 2.5 mg, and Group C (NEO 5 mg. General anesthesia was induced in the three groups using propofol 2.0 mg/kg of corrected body weight (CBW and fentanyl 3 mcg/kg of CBW. Anesthesia was maintained with O2/air/desflurane 1 minimum alveolar concentration. Remifentanil infusion started at 0.05–0.2 mcg/kg/min. Tracheal intubation was facilitated with rocuronium 1.2 mg/kg of CBW guided with PNS. When the train of four (TOF reached zero, intubation was performed using a GlideScope. At the end of surgery, TOF ratio and posttetanic counts were recorded. SUG 2 mg/kg of CBW (Group A, NEO 2.5 mg (Group B, and NEO 5 mg (Group C were administered according to the random envelope. The time to achieve 90% of TOF was recorded in seconds using a timer. ANOVA for repeated measurements was used for statistical analyses. P 90%, the recovery pattern of both was similar.

  3. Heat transfer analysis of the waste-container sleeve/salt configuration

    International Nuclear Information System (INIS)

    Callahan, G.D.; Ratigan, J.L.; Russell, J.E.; Fossum, A.F.

    1975-01-01

    Prior to this investigation, the heat transport considered was only that of straight conduction. The waste container, air gap, and sleeve arrangement was considered to be a single, consistent, time-dependent, heat-generating unit in intimate contact with the salt. The conduction model does not accurately model the heat transfer mechanisms available. Thus radiation and combined radiation and convection must also be considered in the determination of the temperature field. As would be expected, the canister temperatures are higher for the case of radiation across the airgap than those that result from conduction when the canister is in intimate contact with the salt. For the radiation case, the canister temperatures rise rapidly to a temperature of approximately 1,140 0 F and maintain an almost steady state condition for one year whereafter the temperatures slowly decrease. The far field temperatures, near the pillar centerline, are essentially equivalent for all cases. As time proceeds, the far field temperatures of the conduction models are about 15% different

  4. Sleeve lobectomy versus pneumonectomy for non-small cell lung cancer: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Shi Woda

    2012-12-01

    Full Text Available Abstract Aim It is controversial that whether sleeve lobectomy (SL should be promoted more worthy than pneumonectomy (PN in suitable patients. Methods We searched all studies that had been published in English from PUBMED and Embase which compared the short-term and long-term outcomes of SL and pneumonectomy (PN in patients with non-small cell lung cancer (NSCLC. Results Nineteen studies met our criteria with a combined total of 3878 subjects, of which 1316 (33.9% underwent SL and 2562 (66.1% underwent PN. The odds ratio was 0.50 (95% CI: 0.34-0.72 for postoperative mortality, 1.17 (95% CI: 0.82-1.67 for postoperative complications, 0.78 (95% CI: 0.47-1.29 for locoregional recurrences. The risk difference for 1-, 3-, 5- year was 0.11 (95% CI: 0.07-0.14, 0.15 (95% CI: 0.06-0.24, 0.15 (95% CI: 0.09-0.20,respectively. The pooled hazard ratio was 0.63 (95% CI: 0.56-0.71 in favor of SL group. Conclusion SL is more worthy to be done than PN in suitable patients with less mortality and better long-term survival.

  5. Development of ABWR inertia-increased reactor internal pump and thicker sleeve nozzle

    International Nuclear Information System (INIS)

    Takahashi, Shirou; Shiina, Kouji; Matsumura, Seiichi

    2002-01-01

    The conventional reactor internal pumps (RIPs) in the ABWR have an inertia moment coming from the shafts and Motor-Generator sets, enabling the RIPs to continue running for a few seconds, when a trip of all RIPs event occurs. It is possible to simplify the RIPs' power supply system without affecting the core flow supply when the above event occurs by eliminating M-G sets, if the rotating inertia is increased. This inertia increase due to an additional flywheel, which leads to gains in weight and length, requires the larger diameter nozzle with the thicker sleeve. However, too large a nozzle diameter may change the hydraulic performance. In authors' previous study, the optimum nozzle diameter (492 mm) was selected through 1/5-scale test. In this study, the 492 mm nozzle and the inertia-increased RIP were verified through the full-scale tests. The rotating inertia time constant on coastdown characteristics (behavior of the RIP speed in the event of power loss) for the inertia-increased RIP doubled compared with the current RIP. The casing and the shaft vibration were also confirmed to satisfy the design criteria. Moreover, hydraulic performance and heat increase in the motor casing due to the flywheel were evaluated. The inertia increased RIP with the 492 mm nozzle maintained good performance. (author)

  6. Bariatric surgery - effects on obesity and related co-morbidities

    DEFF Research Database (Denmark)

    Svane, Maria Saur; Madsbad, Sten

    2014-01-01

    Laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG) are the three most commonly performed bariatric procedures. Obesity responds well to bariatric surgery, with major long-lasting weight loss that is most pronounced...... vitamins and minerals, and anemia. Some patients have dumping after meals, and a few patients will develop postprandial hypoglycemia after RYGB. About 25% of patients require plastic surgery to provide relief from excessive skin tissue....

  7. Amniotic constriction bands

    Science.gov (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Amniotic band sequence URL of this page: //medlineplus.gov/ency/ ... birth. The baby should be delivered in a medical center that has specialists experienced in caring for babies ... or partial loss of function of a body part. Congenital bands affecting large parts of the body cause the ...

  8. Extended Sleeve Products Allow Control and Monitoring of Process Fluid Flows Inside Shielding, Behind Walls and Beneath Floors - 13041

    Energy Technology Data Exchange (ETDEWEB)

    Abbott, Mark W. [Flowserve Corporation, 1978 Foreman Drive Cookeville, TN 38506 (United States)

    2013-07-01

    Throughout power generation, delivery and waste remediation, the ability to control process streams in difficult or impossible locations becomes increasingly necessary as the complexity of processes increases. Example applications include radioactive environments, inside concrete installations, buried in dirt, or inside a shielded or insulated pipe. In these situations, it is necessary to implement innovative solutions to tackle such issues as valve maintenance, valve control from remote locations, equipment cleaning in hazardous environments, and flow stream analysis. The Extended Sleeve family of products provides a scalable solution to tackle some of the most challenging applications in hazardous environments which require flow stream control and monitoring. The Extended Sleeve family of products is defined in three groups: Extended Sleeve (ESV), Extended Bonnet (EBV) and Instrument Enclosure (IE). Each of the products provides a variation on the same requirements: to provide access to the internals of a valve, or to monitor the fluid passing through the pipeline through shielding around the process pipe. The shielding can be as simple as a grout filled pipe covering a process pipe or as complex as a concrete deck protecting a room in which the valves and pipes pass through at varying elevations. Extended Sleeves are available between roughly 30 inches and 18 feet of distance between the pipeline centerline and the top of the surface to which it mounts. The Extended Sleeve provides features such as ± 1.5 inches of adjustment between the pipeline and deck location, internal flush capabilities, automatic alignment of the internal components during assembly and integrated actuator mounting pads. The Extended Bonnet is a shorter fixed height version of the Extended Sleeve which has a removable deck flange to facilitate installation through walls, and is delivered fully assembled. The Instrument Enclosure utilizes many of the same components as an Extended Sleeve

  9. Comparison of Quality of Life and Nutritional Status in Gastric Cancer Patients Undergoing Gastrectomies.

    Science.gov (United States)

    Lim, Hee-Sook; Cho, Gyu-Seok; Park, Yoon-Hyung; Kim, Soon-Kyung

    2015-07-01

    The aim of this study was to compare the quality of life (QoL) depending on the postoperative survival period or nutritional status in gastric cancer patients. Surviving gastric cancer patients (n = 222) after the gastrectomy were included in the study at Soonchunhyang University Bucheon Hospital from April 2010 to August 2012. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and a gastric cancer-specific module, the EORTC QLQ-STO22, were used to assess the QoL. The postoperative survival period of the patients fell into two groups; the less-than-1-year group or the more-than-1-year group, and the nutritional status of the patients fell into three groups by a score of patient generated-subjective global assessment (SGA)-A, B, and C. As a result, the rate of malnutrition was 34.5% in the less-than-1-year group and 19.8% in the more-than-1-year group, respectively. Score for the fatigue (p = 0.006), loss of appetite (p = 0.002), reflux (p = 0.027) and body image (p = 0.004) in which the QoL was significantly lower in the less-than-1-year group than in the more-than-1-year group. The score of QoL according to the nutritional status of all subjects, overall health status (p = 0.043), physical functioning (p = 0.016), fatigue (p = 0.006), pain (p = 0.028), loss of appetite (p = 0.017), reflux (p = 0.003), eating restriction (p = 0.002), anxiety (p = 0.010), and body image (p = 0.001) was significantly lower in the SGA-C group than in other SGA groups. These results suggest that the nutritional status of the gastrectomy patients with stomach cancer may impact on their QoL. It is necessary to to develop nutritional intervention to improve QoL in gastric cancer patients with postoperative malnutrition.

  10. Band parameters of phosphorene

    International Nuclear Information System (INIS)

    Lew Yan Voon, L C; Wang, J; Zhang, Y; Willatzen, M

    2015-01-01

    Phosphorene is a two-dimensional nanomaterial with a direct band-gap at the Brillouin zone center. In this paper, we present a recently derived effective-mass theory of the band structure in the presence of strain and electric field, based upon group theory. Band parameters for this theory are computed using a first-principles theory based upon the generalized-gradient approximation to the density-functional theory. These parameters and Hamiltonian will be useful for modeling physical properties of phosphorene. (paper)

  11. Infrared diffuse interstellar bands

    Science.gov (United States)

    Galazutdinov, G. A.; Lee, Jae-Joon; Han, Inwoo; Lee, Byeong-Cheol; Valyavin, G.; Krełowski, J.

    2017-05-01

    We present high-resolution (R ˜ 45 000) profiles of 14 diffuse interstellar bands in the ˜1.45 to ˜2.45 μm range based on spectra obtained with the Immersion Grating INfrared Spectrograph at the McDonald Observatory. The revised list of diffuse bands with accurately estimated rest wavelengths includes six new features. The diffuse band at 15 268.2 Å demonstrates a very symmetric profile shape and thus can serve as a reference for finding the 'interstellar correction' to the rest wavelength frame in the H range, which suffers from a lack of known atomic/molecular lines.

  12. Band parameters of phosphorene

    DEFF Research Database (Denmark)

    Lew Yan Voon, L. C.; Wang, J.; Zhang, Y.

    2015-01-01

    Phosphorene is a two-dimensional nanomaterial with a direct band-gap at the Brillouin zone center. In this paper, we present a recently derived effective-mass theory of the band structure in the presence of strain and electric field, based upon group theory. Band parameters for this theory...... are computed using a first-principles theory based upon the generalized-gradient approximation to the density-functional theory. These parameters and Hamiltonian will be useful for modeling physical properties of phosphorene....

  13. Wear Resistance of Piston Sleeve Made of Layered Material Structure: MMC A356R, Anti-Abrasion Layer and FGM Interface

    Directory of Open Access Journals (Sweden)

    Hernik Szymon

    2016-09-01

    Full Text Available The aim of this paper is the numerical analysis of the one of main part of car engine – piston sleeve. The first example is for piston sleeve made of metal matrix composite (MMC A356R. The second improved material structure is layered. Both of them are comparison to the classical structure of piston sleeve made of Cr-Ni stainless steel. The layered material structure contains the anti-abrasion layer at the inner surface of piston sleeve, where the contact and friction is highest, FGM (functionally graded material interface and the layer of virgin material on the outer surface made of A356R. The complex thermo-elastic model with Archard's condition as a wear law is proposed. The piston sleeve is modelling as a thin walled cylindrical axisymmetric shell. The coupled between the formulation of thermo-elasticity of cylindrical axisymmetric shell and the Archard’s law with functionally changes of local hardness is proposed.

  14. CSF oligoclonal banding - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100145.htm CSF oligoclonal banding - series—Normal anatomy To use the ... 5 out of 5 Overview The cerebrospinal fluid (CSF) serves to supply nutrients to the central nervous ...

  15. Decay of superdeformed bands

    International Nuclear Information System (INIS)

    Carpenter, M.P.; Khoo, T.L.; Lauritsen, T.

    1995-01-01

    One of the major challenges in the study of superdeformation is to directly connect the large number of superdeformed bands now known to the yrast states. In this way, excitation energies, spins and parities can be assigned to the levels in the second well which is essential to establish the collective and single-particle components of these bands. This paper will review some of the progress which has been made to understand the decay of superdeformed bands using the new arrays including the measurement of the total decay spectrum and the establishment of direct one-step decays from the superdeformed band to the yrast line in 194 Hg. 42 refs., 5 figs

  16. Laparoscopic gastric banding

    Science.gov (United States)

    ... eat by making you feel full after eating small amounts of food. After surgery, your doctor can adjust the band ... You will feel full after eating just a small amount of food. The food in the small upper pouch will ...

  17. Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: A single-center 7-year experience

    Science.gov (United States)

    Chen, Ke; Pan, Yu; Cai, Jia-Qin; Xu, Xiao-Wu; Wu, Di; Yan, Jia-Fei; Chen, Rong-Gao; He, Yang; Mou, Yi-Ping

    2016-01-01

    AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy (LTG) for gastric cancer. METHODS: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records. RESULTS: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 mL. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%. However, there were no cases of postoperative death. CONCLUSION: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness. PMID:27022225

  18. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Min-Chan Kim; Ghap-Joong Jung; Hyung-Ho Kim

    2005-01-01

    AIM: To evaluate the nature of the "learning curve" for laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer. METHODS: The data of 90 consecutive patients with early gastric cancer who underwent LADG with systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The 90 patients were divided into 9 sequential groups of 10 cases in each group and the average operative time of these 9 groups were determined. Other learning indicators, such as transfusion requirements, conversion rates to open surgery, postoperative complication, time to first flatus, and postoperative hospital stay, were evaluated. RESULTS: After the first 10 LADGs, the operative time reached its first plateau (230-240 min/operation) and then reached a second plateau (<200 min/operation) for the final 30 cases. Although a significant improvement in the operative time was noted after the first 50 cases, there were no significant differences in transfusion requirements, conversion rates to open surgery, postoperative complications, time to first flatus, or postoperative hospital stay between the groups. CONCLUSION: Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.

  19. Prognostic nutritional index is associated with survival after total gastrectomy for patients with gastric cancer.

    Science.gov (United States)

    Ishizuka, Mitsuru; Oyama, Yusuke; Abe, Akihito; Tago, Kazuma; Tanaka, Genki; Kubota, Keiichi

    2014-08-01

    To investigate the influence of clinical characteristics including nutritional markers on postoperative survival in patients undergoing total gastrectomy (TG) for gastric cancer (GC). One hundred fifty-four patients were enrolled. Uni- and multivariate analyses using the Cox proportional hazard model were performed to explore the most valuable clinical characteristic that was associated with postoperative survival. Multivariate analysis using twelve clinical characteristics selected from univariate analyses revealed that age (≤ 72/>72), carcinoembryonic antigen (≤ 20/>20) (ng/ml), white blood cell count (≤ 9.5/>9.5) (× 10(3)/mm(3)), prognostic nutritional index (PNI) (≤ 45/>45) and lymph node metastasis (negative/positive) were associated with postoperative survival. Kaplan-Meier analysis and log-rank test showed that patients with higher PNI (>45) had a higher postoperative survival rate than those with lower PNI (≤ 45) (p<0.001). PNI is associated with postoperative survival of patients undergoing TG for GC and is able to divide such patients into two independent groups before surgery. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  20. Impact of nutritional status on outcomes in laparoscopy-assisted gastrectomy.

    Science.gov (United States)

    Nagata, Tomoyuki; Nakase, Yuen; Nakamura, Kei; Sougawa, Akira; Mochiduki, Satoshi; Kitai, Shozo; Inaba, Seishiro

    2017-11-01

    There is a high morbidity rate after digestive surgery in patients with nutritional disorders such as high body mass index and depletion of skeletal muscle. The ratio of psoas muscle area to trunk area was defined as the Psoas and All trunk Ratio (PandA Ratio) and used as an index of the balance between muscle and adipose tissue. This ratio was determined in 77 patients undergoing laparoscopy-assisted gastrectomy (LAG) for gastric cancer. Patients were classified into groups with and without postoperative complications. Clinicopathological factors were compared between the groups, and relationships of PandA Ratio with other nutritional indices were examined. PandA Ratios were also analyzed in males and females in each Clavien-Dindo grade. Complications developed in 22 patients (28.6%) after LAG. The PandA Ratio was significantly lower in patients with complications in univariate (2.76 ± 0.22% versus 3.66 ± 0.14%, P = 0.0009) and multivariate (P = 0.0064) analyses. A low PandA Ratio was also associated with more severe complications in males. Measurement of the areas of the psoas muscle and trunk on CT is useful for evaluation of the balance between skeletal and adipose tissue. The PandA Ratio derived from these measurements is a predictor of the clinical course after LAG in males. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Educational system of laparoscopic gastrectomy for trainee-how to teach, how to learn.

    Science.gov (United States)

    Kaito, Akio; Kinoshita, Takahiro

    2017-01-01

    The feasibility of laparoscopic gastrectomy (LG) has been gradually proven by several scientific works, however, proper training method for this kind of surgery are still under investigation and debate. Here we report our educational system of LG to enhance the skill of young surgeons in our hospital. Our training program for trainee consists of 3 years of junior residency and 2 years of senior residency programs, requiring 5 years in total. In order to master LG, three following factors seem to be essential: learning, practice and experience. Learning means that trainee study techniques and concepts by educational materials, such as operative videos, lectures, or textbook. Practice means animal laboratory training or dry box training to acquire hand-eye coordination or bi-hand coordination, leading to precise movement of surgical devices. Experience means actual on-site training, participating in clinical LG as scopist, assistant or operator. In the actual surgery, we have some common principles for scopist, assistant and operator, respectively, and these principles are shared by entire surgical team. These principles are transmitted from trainer to trainee using simple keywords repeatedly. In conclusion, combination and balance of the three factors, learning, practice and experience are necessary to efficiently advance education of LG for trainee and may leads to benefits for gastric cancer patients.

  2. [A Case of Intestinal Obstruction Caused by a Bezoar after Pylous-Preserving Gastrectomy].

    Science.gov (United States)

    Yamazato, Yuzo; Kosuga, Toshiyuki; Ichikawa, Daisuke; Kubota, Takeshi; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Arita, Tomohiro; Morimura, Ryo; Murayama, Yasutoshi; Kuriu, Yoshiaki; Ikoma, Hisashi; Nakanishi, Masayoshi; Otsuji, Eigo

    2017-11-01

    A 65-year-old woman with a history of pylorus-preserving gastrectomy(PPG)for early gastric cancer visited our hospital because of vomiting. Gastrointestinal endoscopy revealed a large bezoar in the anastomotic site of the stomach. Because the bezoar was too large to be collected orally, the dissolution therapy with taking Coca-Cola®was continued. On the 3rd day after hospitalization, she felt acute abdominal pain with vomiting. Computed tomography revealed intestinal obstruction by a mass with air bubbles inside in the ileum. Emergency operation was performed under a diagnosis of intestinal obstruction due to the bezoar. The black brown bezoar sized 80×35×30mm was extracted through an ileotomy. The delayed gastric empty is considered to involve in the bezoar formation. Therefore, the appropriate education of diet and periodic endoscopic screening are necessary for patients with large amounts of gastric residues especially after PPG. In the dissolution therapy, physicians need to be careful of intestinal obstruction by a bezoar.

  3. Nuclear fuel assembly grid sleeve/guide thimble bulge orientation gage and inspection method

    International Nuclear Information System (INIS)

    Widener, W.H.

    1988-01-01

    This patent describes a method of inspecting a fuel assembly to determine the orientation of externally-projecting mated bulges connecting a grid sleeve to a guide thimble of the assembly, the method comprising the steps of: (a) inserting a radially-expandable tubular member within the guide thimble, the tubular member having externally-projecting embossments thereon spaced circumferentially from one another about the tubular member, the embossments being the same in number as the bulges of the guide thimble and configured to fit therewithin; (b) axially moving an elongated expansion member, which extends through and rotatably mounts the tubular member, relative to the tubular member from a first position in which the expansion member permits inward contraction of the tubular member and displacement of embossments thereon away from the interior of the guide thimble bulges for removing the embossments from registry therewith and a second position in which the expansion member produces radial expansion of the tubular member and displacement of the embossments thereon toward the interior of the guide thimble bulges for placing the embossments in registry therewith; (c) rotating the tubular member relative to the expansion member so as to bring the embossments on the tubular member into alignment with the guide thimble bulges as the embossments on the tubular member are being displaced toward and into registry with the interior of the bulges; and (d) responsive to rotation of the tubular member away from a reference position, providing an indication of the orientation of the guide thimble bulges relative to a reference point upon displacement of the embossments into registry therewith

  4. Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function in Marfan Syndrome Patients.

    Science.gov (United States)

    Aalaei-Andabili, Seyed Hossein; Martin, Tomas; Hess, Philip; Klodell, Charles; Karimi, Ashkan; Arnaoutakis, George; Lee, Teng; Beaver, Thomas

    2017-09-01

    The Florida sleeve (FS) procedure was developed as a simplified approach for repair of functional type I aortic insufficiency secondary to aortic root aneurysm. We evaluated postoperative aortic valve function, long-term survival, and freedom from reoperation in Marfan syndrome patients who underwent the FS procedure at our center. All Marfan syndrome patients undergoing FS procedure from May 2002 to December 2014 were included. Echocardiography assessment included left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), ejection fraction, and degree of aortic insufficiency (none = 0, minimal = 1, mild = 2, moderate = 3, severe = 4). Social Security Death Index and primary care physicians' report were used for long-term follow-up. Thirty-seven Marfan syndrome patients, 21 (56.8%) men and 16 (43%) women with mean age of 35.08 ± 13.45 years underwent FL repair at our center. There was no in-hospital or 30-day death or stroke. Two patients required reoperation due to bleeding. Patients' survival rate was 94% at 1 to 8 years. Freedom from reoperation was 100% at 8 years. Twenty-five patients had postoperative follow-up echocardiography at 1 week. Aortic insufficiency grade significantly decreased after the procedure (preoperative mean ± SD: 1.76 ± 1.2 versus 1-week postoperative mean ± SD: 0.48 ± 0.71, p Marfan syndrome patients with immediate improvement in aortic valve function. Long-term survival and freedom from reoperation rates are encouraging. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection

    Directory of Open Access Journals (Sweden)

    Anita Joselyn

    2015-01-01

    Full Text Available Purpose: One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection. Materials and Methods: With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure. Results: This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024. Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS. No difference was noted in the postoperative pain scores. Conclusion: Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.

  6. Endurance in Al Alloy Melts and Wear Resistance of Titanium Matrix Composite Shot-Sleeve for Aluminum Alloy Die-casting

    International Nuclear Information System (INIS)

    Choi, Bong-Jae; Kim, Young-Jig; Sung, Si-Young

    2012-01-01

    The main purpose of this study was to evaluate the endurance against Al alloy melts and wear resistance of an in-situ synthesized titanium matrix composite (TMC) sleeve for aluminum alloy die-casting. The conventional die-casting shot sleeve material was STD61 tool steel. TMCs have great thermal stability, wear and oxidation resistance. The in-situ reaction between Ti and B4C leads to two kinds of thermodynamically stable reinforcements, such as TiBw and TiCp. To evaluate the feasibility of the application to a TMCs diecasting shot sleeve, the interfacial reaction behavior was examined between Al alloys melts with TMCs and STD61 tool steel. The pin-on-disk type dry sliding wear test was also investigated for TMCs and STD61 tool steel.

  7. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial.

    Science.gov (United States)

    Hu, Yanfeng; Huang, Changming; Sun, Yihong; Su, Xiangqian; Cao, Hui; Hu, Jiankun; Xue, Yingwei; Suo, Jian; Tao, Kaixiong; He, Xianli; Wei, Hongbo; Ying, Mingang; Hu, Weiguo; Du, Xiaohui; Chen, Pingyan; Liu, Hao; Zheng, Chaohui; Liu, Fenglin; Yu, Jiang; Li, Ziyu; Zhao, Gang; Chen, Xinzu; Wang, Kuan; Li, Ping; Xing, Jiadi; Li, Guoxin

    2016-04-20

    The safety and efficacy of radical laparoscopic distal gastrectomy (LG) with D2 lymphadenectomy for the treatment of advanced gastric cancer (AGC) remain controversial. We conducted a randomized controlled trial to compare laparoscopic and conventional open distal gastrectomy with D2 lymph node dissections for AGC. Between September 2012 and December 2014, 1,056 patients with clinical stage T2-4aN0-3M0 gastric cancer were eligible for inclusion. They were randomly assigned to either the LG with D2 lymphadenectomy group (n = 528) or the open gastrectomy (OG) with D2 lymphadenectomy group (n = 528). Fifteen experienced surgeons from 14 institutions in China participated in the study. The morbidity and mortality within 30 days after surgery between the LG (n = 519) and the OG (n = 520) groups were compared on the basis of the modified intention-to-treat principle. Postoperative complications were stratified according to the Clavien-Dindo classification. The compliance rates of D2 lymphadenectomy were similar between the LG and OG groups (99.4% v 99.6%; P = .845). The postoperative morbidity was 15.2% in the LG group and 12.9% in OG group with no significant difference (difference, 2.3%; 95% CI, -1.9 to 6.6; P = .285). The mortality rate was 0.4% for the LG group and zero for the OG group (difference, 0.4%; 95% CI, -0.4 to 1.4; P = .249). The distribution of severity was similar between the two groups (P = .314). Experienced surgeons can safely perform LG with D2 lymphadenectomy for AGC. © 2016 by American Society of Clinical Oncology.

  8. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer

    Science.gov (United States)

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-01-01

    Abstract Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm2/m2 for women and 40.8 cm2/m2 for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. PMID:27043677

  9. Short-term clinical implications of the accessory left hepatic artery in patients undergoing radical gastrectomy for gastric cancer.

    Directory of Open Access Journals (Sweden)

    Chang-Ming Huang

    Full Text Available BACKGROUND: To evaluate the prevalence of the accessory left hepatic artery (ALHA; defined as a vessel arising from the left gastric artery, which, together with a typical left hepatic artery, supplies blood to the left lobe of the liver and its short-term clinical implications in patients undergoing radical gastrectomy for gastric cancer. METHODS: Clinical data of 1173 patients with gastric cancer who underwent laparoscopy-assisted radical gastrectomy were retrospectively analyzed. Groups of patients with and without ALHA were compared to identify differences in intraoperative and postoperative variables and changes in liver function. RESULTS: Of the 1173 patients, 135 (11.5% had an ALHA and 1038 (88.5% did not. There were no significant between-group differences in clinicopathological and intraoperative characteristics, postoperative recovery, and morbidity and mortality rates (P>0.05 each. None of the patients had postoperative symptoms associated with impaired liver function. Glutamic oxaloacetic transaminase (GOT, glutamic pyruvic transaminase (GPT and total bilirubin (TBIL concentrations were similar preoperatively. TBIL concentrations on postoperative days 1, 3, and 7 were similar (P>0.05, while GOT and GPT activities were higher in the ALHA than in the non-ALHA group on days 1 and 7 (P<0.05, with all three markers similar in the two groups on day 14. In patients without chronic liver disease (CLD, GOT, GPT and TBIL concentrations were similar in patients with and without ALHA; whereas, in patients with CLD, GOT and GPT concentrations on days 1 and 3 and GOT on day 7 were higher in patients with than without ALHA. CONCLUSION: ALHA is a common anomaly that was found in 11.5% of patients. It can be safely severed during radical gastrectomy in patients without CLD, but should be left intact in patients with CLD to prevent liver dysfunction. If severed in the latter, the patient should be monitored and liver-protecting therapy may be

  10. Long-term Shifting Patterns in Quality of Life After Distal Subtotal Gastrectomy: Preoperative- and Healthy-based Interpretations.

    Science.gov (United States)

    Lee, Seung Soo; Chung, Ho Young; Kwon, Ohkyoung; Yu, Wansik

    2015-06-01

    The study assessed long-term shifting patterns in quality of life (QoL) after distal subtotal gastrectomy relative to an estimated healthy population QoL (HPQoL), and compared them to shifting patterns interpreted in terms of a preoperative QoL baseline. QoL data from 127 gastric cancer patients who underwent open distal subtotal gastrectomy were obtained at the preoperative period and at 6, 12, 18, 24, and 36 months after surgery. QoL data obtained from 127 age- and sex-adjusted healthy individuals were used to estimate HPQoL. The study used the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30 (QLQ-C30) and a gastric cancer module (QLQ-STO22) to assess QoL. Comparisons were made between preoperative-based and healthy-based interpretations of longitudinal QoL shifting patterns. Among the persistently deteriorated QoL variables indicated by the preoperative-based interpretation (physical functioning, role functioning, cognitive functioning, nausea and vomiting, dyspnea, diarrhea, dysphagia, eating restrictions, dry mouth, and body image), eating restrictions and body image concerns were the only factors indicated by a healthy-based interpretation. In this interpretation, financial difficulties were evident at the preoperative period and persisted for at least 36 months. When preoperative QoL was used as a baseline, decreased QoL due to financial difficulties was not revealed. Persistent QoL deterioration after distal subtotal gastrectomy is primarily due to financial difficulties, eating restrictions, and body image concerns. Preoperative-based interpretation of postoperative QoL may exaggerate the persistency of reduced QoL and conceal on-going QoL deterioration after surgery.

  11. Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Objective: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS in patients undergoing laparoscopic assisted total gastrectomy. Materials And Methods: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22 patients received enhanced recovery programme (ERAS management and rest twenty-five (n = 25 conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. Results: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h when compared to conventional group (140 ± 28 h. ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h. There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43 g/L vs. (73.07 ± 19.32 g/L, d3 (126.10 ± 18.62 g/L vs. (160.72 ± 26.18 g/L]. Conclusion: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.

  12. Clinical Outcomes of the Marginal Ulcer Bleeding after Gastrectomy: As Compared to the Peptic Ulcer Bleeding with Nonoperated Stomach

    Science.gov (United States)

    Chung, Woo Chul; Jeon, Eun Jung; Lee, Kang-Moon; Paik, Chang Nyol; Oh, You Suk; Lee, Yang Woon; Kim, Sang Bae; Jun, Kyong-Hwa; Chin, Hyung Min

    2012-01-01

    Background. Marginal ulcer is a well-known complication after gastrectomy. Its bleeding can be severe, but the severity has rarely been reported. We aim to evaluate the clinical outcomes of marginal ulcer bleeding (MUB) as compared to peptic ulcer bleeding (PUB) with nonoperated stomach. Methods. A consecutive series of patients who had nonvariceal upper gastrointestinal bleeding and admitted to the hospital between 2005 and 2011 were retrospectively analyzed. A total of 530 patients were enrolled in this study, and we compared the clinical characteristics between 70 patients with MUB and 460 patients with PUB. Results. Patients with MUB were older (mean age: 62.86 ± 10.59 years versus 53.33 ± 16.68 years, P = 0.01). The initial hemoglobin was lower (8.16 ± 3.05 g/dL versus 9.38 ± 2.49 g/dL, P = 0.01), and the duration of admission was longer in MUB (7.14 ± 4.10 days versus 5.90 ± 2.97 days, P = 0.03). After initial hemostasis, the rebleeding rate during admission was higher (16.2% versus 6.5%, P = 0.01) in MUB. However, the mortality rate did not differ statistically between MUB and PUB groups. Helicobacter pylori-positive rate with MUB was lower than that of PUB (19.4% versus 54.4%, P = 0.01). Conclusions. Clinically, MUB after gastrectomy is more severe than PUB with nonoperated stomach. Infection with H. pylori might not appear to play an important role in MUB after gastrectomy. PMID:23304127

  13. Thermoelastic/plastic analysis of waste-container sleeve: IV. Air gap influence on hole closure. Technical memorandum report (RSI-0019)

    International Nuclear Information System (INIS)

    Pariseau, W.G.

    1975-01-01

    A thermoelastic/plastic finite element analysis of the influence of an air-gap on hole closure about a waste-container/sleeve assembly emplaced in a typical repository room (SALT/4T Model) indicates that hole closure would be of the order of hundredths of an inch. Acceptable air-gap width is thus governed by the hole size required for emplacement efficiency. A refined mesh analysis and laboratory testing is suggested in order to further explore the possibility of eliminating the engineering necessity of the sleeve

  14. J-pouch versus Roux-en-Y reconstruction after gastrectomy: functional assessment and quality of life (randomized trial

    Directory of Open Access Journals (Sweden)

    Zonca P

    2016-12-01

    Full Text Available Pavel Zonča,1,2 Tomáš Malý,3 Peter Ihnát,1,2 Matus Peteja,1,2 Otakar Kraft,4 Kamil Kuca2,5 1Department of Surgery, University Hospital Ostrava, 2Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, 3Department of Surgery, University Hospital Olomouc, Olomouc, 4Department of Nuclear Medicine, University Hospital Ostrava, Ostrava, 5Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic Purpose: The aim of this study was to evaluate the quality of life and functional emptying of J-pouch versus Roux-en-Y reconstruction after total gastrectomy for malignancy. Methods: This study was designed as a prospective, nonblinded, randomized, parallel clinical trial (Trial Number: MN Ostrava, 200604. With informed consent, patients undergoing gastrectomy for malignancy were randomized to J-pouch or Roux-en-Y reconstruction. The time taken for a test semisolid meal labeled with 99mTc-sulfur colloid to exit the reconstructed parts was measured by dynamic scintigraphy 1 year after resection. Quality of life was measured using the Eypasch questionnaire at the same time as functional emptying assessment. This trial was investigator-initiated. Results: In all, 72 patients were included into the study. The time taken for the test meal to exit the postgastrectomy reconstruction was 16.5±10.0 minutes (mean ± standard deviation in the Roux-en-Y group and 89.4±37.8 minutes in the “J-pouch” group; the difference was statistically significant (P<0.001. Emptying of the J-pouch appeared to be a linear decreasing function compared to the exponential pattern seen in the Roux-en-Y group. The quality of life measurement showed scores of 106±18.8 points (mean ± standard deviation in the Roux-en-Y group compared to 122±22.5 points in the J-pouch group; the difference was statistically significant (P=0.0016. There were no important adverse events. Conclusion: After total gastrectomy, a J

  15. Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Han-Cheng Liu; Yan-Bing Zhou; Dong Chen; Zhao-Jian Niu; Yang Yu

    2012-01-01

    AIM:To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy.METHODS:Within 24 h of intensive care unit management,patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L.Resting energy expenditure (REE),respiratory quotient (RQ),resting energy expenditure per kilogram (REE/kg),and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system.The changes in body composition were analyzed by multi-frequency bioimpedance analysis.Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance.RESULTS:Sixty patients were enrolled.Compared with preoperative baseline,postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05,respectively) on postoperative days 1 and 3 in the IIT group.Meanwhile the concentration of total protein,albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05,respectively).Compared with the CIT group,IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg,P =0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg,P =0.013); and decreased the Ln-HOMA-IR score (P =0.019,0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P

  16. CT after gastrectomy for gastric carcinoma : significance of soft tissue surrounding the celiac axis

    International Nuclear Information System (INIS)

    Baek, Seung Yon; Kim, Hae Young; Choi, Hye Young; Lee, Sun Wha; Ko, Eun Joo; Lee, Myung Sook

    1997-01-01

    To evaluate whether soft tissue surrounding the celiac axis, as seen on abdominal CT imaging after gastrectomy for gastric carcinoma, should be considered as the recurrence of carcinoma or postoperative change. One hundred and forty-one abdominal CT examinations of 71 patients who had undergone subtotal or total gastrectomy for gastric carcinoma were included in our study. Conventional CT scans were obtained with 1cm thickness and interval from the diaphragm to the kidneys after contrast enhancement. It was considered that carcinoma had not recurred if findings were negative on UGI series, endoscopy with biopsy and a normal level of carcinoembryonic antigen except for soft tissue surrounding the celiac axis on abdominal CT. We then divided subjects into a recurrence group(N=20) and normal group(N=51) and on initial follow-up CT(FU-CT), analyzed the incidence, margin, shape, extent, degree and pattern of attenuation of the soft tissue surrounding the celiac axis in both groups. Since the second FU-CT examination, we observed changes in the soft tissue surrounding the celiac axis. On initial follow-up CT, at mean 308 days after surgery, fifty-five percent(39/71) of total patients (70%(14/20) of the recurrence group and 49%(25/51) of the normal group) showed soft tissue surrounding the celiac axis. The margin was distinct in 12(86%) of the recurrence group and indistinct in 21(84%) of the normal group(p<0.001). Twelve (86%) of the recurrence group showed a nodular or confluent nodular shape and 21(84%) of the normal group showed a permeative shape (p<0.001). Extent was unilateral in eight (57%) of the recurrence group and bilateral in 16(64%) of the normal group. Attenuation was similar to that of the spleen and muscle in seven(50%) of the recurrence group and was similar to that of muscle in 18(72%) of the normal group. The pattern of attenuation was homogeneous in 13(93%) of the recurrence group and 21(84%) of the normal group. There was no significant difference in

  17. Ultra wide band antennas

    CERN Document Server

    Begaud, Xavier

    2013-01-01

    Ultra Wide Band Technology (UWB) has reached a level of maturity that allows us to offer wireless links with either high or low data rates. These wireless links are frequently associated with a location capability for which ultimate accuracy varies with the inverse of the frequency bandwidth. Using time or frequency domain waveforms, they are currently the subject of international standards facilitating their commercial implementation. Drawing up a complete state of the art, Ultra Wide Band Antennas is aimed at students, engineers and researchers and presents a summary of internationally recog

  18. Magnet-Sleeve-Sealed Mini Trochoidal-Gear Pump Prototype with Polymer Composite Gear

    Directory of Open Access Journals (Sweden)

    Pedro Javier Gamez-Montero

    2017-09-01

    Full Text Available The trochoidal-gear technology has been growing in groundbreaking fields. Forthcoming applications are demanding to this technology a step forward in the conceiving stage of positive displacement machines. The compendium of the qualities and the inherent characteristics of trochoidal-gear technology, especially towards the gerotor pump, together with scale/size factor and magnetic-driven transmission has led to the idea of a magnet-sleeve-sealed variable flow mini trochoidal-gear pump. From its original concept, to the last phase of the design development, the proof of concept, this new product will intend to overcome problems such as noise, vibration, maintenance, materials, and dimensions. The paper aims to show the technological path followed from the concept, design, and model, to the manufacture of the first prototype, where the theoretical and numerical approaches are not always directly reflected in the prototype performance results. Early in the design process, from a standard-commercial sintered metal mini trochoidal-gear unit, fundamental characteristics and dimensional limitations have been evaluated becoming the strategic parameters that led to its configuration. The main technical challenge to confront is being sealed with non-exterior driveshaft, ensuring that the whole interior is filled and wetted with working fluid and helping the hydrodynamic film formation, the pumping effect, and the heat dissipation. Subsequently, the mini pump architecture, embodiment, methodology, materials, and manufacture are presented. The trend of applications of polymer composite materials and their benefits wanted to be examined with this new mini pump prototype, and a pure polyoxymethylene mini trochoidal-gear set has been designed and manufactured. Finally, both the sintered and the polymer trochoidal-gear units have been experimentally tested in an in-house full-instrumented mini test bench. Although the main goal of the presented work is the

  19. The Hit and Away technique: optimal usage of the ultrasonic scalpel in laparoscopic gastrectomy.

    Science.gov (United States)

    Irino, Tomoyuki; Hiki, Naoki; Ohashi, Manabu; Nunobe, Souya; Sano, Takeshi; Yamaguchi, Toshiharu

    2016-01-01

    Thermal injury and unexpected bleeding caused by ultrasonic scalpels can lead to fatal complications in laparoscopic gastrectomy (LG), such as postoperative pancreatic fistulas (POPF). In this study, we developed the "Hit and Away" protocol for optimal usage of the ultrasonic scalpel, which in essence involves dividing tissues and vessels in batches using the tip of the scalpel to control tissue temperature. To assess the effectiveness of the technique, the surface temperature of the mesocolon of female swine after ultrasonic scalpel activations was measured, and tissue samples were collected to evaluate microscopic thermal injury to the pancreas. In parallel, we retrospectively surveyed 216 patients who had undergone LG before or after the introduction of this technique and assessed the ability of this technique to reduce POPF. The tissue temperature of the swine mesocolon reached 43 °C, a temperature at which adipose tissue melted but fibrous tissue, including vessels, remained intact. The temperature returned to baseline within 3 s of turning off the ultrasonic scalpel, demonstrating the advantage of using ultrasonic scalpel in a pulsatile manner. Tissue samples from the pancreas demonstrated that the extent of thermal injury post-procedure was limited to the capsule of the pancreas. Moreover, with respect to the clinical outcomes before and after the introduction of this technique, POPF incidence decreased significantly from 7.8 to 1.0% (p = 0.021). The "Hit and Away" technique can reduce blood loss and thermal injury to the pancreas and help to ensure the safety of lymph node dissection in LG.

  20. Abdominal Drainage and Amylase Measurement for Detection of Leakage After Gastrectomy for Gastric Cancer.

    Science.gov (United States)

    Schots, Judith P M; Luyer, Misha D P; Nieuwenhuijzen, Grard A P

    2018-05-07

    To investigate the value of daily measurement of drain amylase for detecting leakage in gastric cancer surgery. This was a retrospective analysis including all patients who underwent a gastrectomy for gastric cancer. From January 2013 until December 2015, an intra-abdominal drain was routinely placed. Drain amylase was measured daily. Receiver operator characteristic curves were created to assess the ability of amylase to predict leakage. Sensitivity, specificity, and negative and positive predictive value of amylase in drain fluid were determined. Leakage of the gastrojejunostomy or esophagojejunostomy, enteroenterostomy, duodenal stump, or pancreas was diagnosed by CT scan, endoscopy, or during re-operation. From January 2016 until April 2017, no drain was inserted. Surgical outcome and postoperative complications were compared between both groups. Median drain amylase concentrations were higher for each postoperative day in patients with leakage. The optimal cutoff value was 1000 IU/L (sensitivity 77.8%, specificity 98.2%, negative predictive value 96.6%). Sixty-seven consecutive procedures were performed with a drain and 40 procedures without. No differences in group characteristics were observed except for gender. Fourteen patients (13.1%) had a leakage. The incidence and severity of leakage were not different between the patients with and without a drain. There was no significant difference in time to diagnosis (1 vs. 0 days; p 0.34), mortality rate (7.5 vs. 2.5%; p 0.41), and median length of hospital stay (9 days in both groups; p 0.46). Daily amylase measurement in drain fluid does not influence the early recognition and management of leakage in gastric cancer surgery.

  1. BREAST CANCER METASTASIS IN THE STOMACH: WHEN THE GASTRECTOMY IS INDICATED ?

    Science.gov (United States)

    Rodrigues, Marcus Vinicius Rozo; Tercioti-Junior, Valdir; Lopes, Luiz Roberto; Coelho-Neto, João de Souza; Andreollo, Nelson Adami

    2016-01-01

    Breast cancer is the most common malignant neoplasm in the female population. However, stomach is a rare site for metastasis, and can show up many years after initial diagnosis and treatment of the primary tumor. Analyze a case series of this tumor and propose measures that can diagnose it with more precocity. Were analyzed 12 patients with secondary gastric tumors. Immunohistochemistry has demonstrated that primary tumor was breast cancer. We retrieved information of age, histological type, interval between diagnosis of the primary breast cancer and its metastases, immunohistochemistry results, treatment and survival. The mean age was 71.3 years (ranging 40-86). Ten cases had already been underwent mastectomy in the moment of the diagnosis of gastric metastasis. Two patients had diagnosis of both primary and secondary tumors concomitantly. At average, diagnosis of gastric metastasis was seven years after diagnosis of primary breast cancer (ranging 0-13). Besides, nine cases had also metastases in other organs, being bones the most affected ones. Immunohistochemistry of the metastases has shown positivity for CK7 antibody in 83.34%, estrogen receptor in 91.67%, progesterone receptor in 66.67% and AE1AE3 antibody in 75%, considering all 12 cases. Moreover, CK20 was absent significantly (66.67%). The positivity of BRST2 marker did not present statistical significance (41.67%). Eight cases were treated with chemotherapy associated or not with hormonal blockade. Surgical treatment of gastric metastasis was performed in four cases: three of them with total gastrectomy and one with distal gastrectomy. Follow-up has shown a mean survival of 14.58 months after diagnosis of metastasis, with only two patients still alive. Patients with a history of breast cancer presenting endoscopic diagnosis of gastric cancer it is necessary to consider the possibility of gastric metastasis of breast cancer. The confirmation is by immunohistochemistry and gastrectomy should be oriented in

  2. Band-notched spiral antenna

    Science.gov (United States)

    Jeon, Jae; Chang, John

    2018-03-13

    A band-notched spiral antenna having one or more spiral arms extending from a radially inner end to a radially outer end for transmitting or receiving electromagnetic radiation over a frequency range, and one or more resonance structures positioned adjacent one or more segments of the spiral arm associated with a notch frequency band or bands of the frequency range so as to resonate and suppress the transmission or reception of electromagnetic radiation over said notch frequency band or bands.

  3. Low Preoperative Prognostic Nutritional Index Predicts Poor Survival Post-gastrectomy in Elderly Patients with Gastric Cancer.

    Science.gov (United States)

    Sakurai, Katsunobu; Tamura, Tatsuro; Toyokawa, Takahiro; Amano, Ryosuke; Kubo, Naoshi; Tanaka, Hiroaki; Muguruma, Kazuya; Yashiro, Masakazu; Maeda, Kiyoshi; Ohira, Masaichi; Hirakawa, Kosei

    2016-10-01

    Preoperative nutritional status may predict short- and long-term outcomes of patients with cancer. The aim of this study was to clarify the impact of preoperative nutritional status on outcomes of elderly patients who have undergone gastrectomy for gastric cancer (GC). A review examining 147 patients treated for GC by gastrectomy at our institution between January 2004 and December 2011 was conducted. Onodera's prognostic nutritional index (PNI) was invoked, using an optimal cutpoint to stratify patients by high (PNI > 43.8; n = 84) or low (PNI ≤ 43.8; n = 63) nutritional status. Clinicopathologic features and short- and long-term outcomes, including the cause of death, were compared. In multivariate analysis, low PNI was identified as an independent correlate of poor 5-year overall survival (OS). In subgroup analysis, 5-year OS rates for patients with stage 1 GC were significantly worse in the low PNI (vs. high PNI) patient subset, which also posed a significantly higher risk of death from other disease; however, 5-year cancer-specific survival and PNI were unrelated. Deaths from recurrence in both groups were statistically similar, and morbidity rates did not differ significantly by group. PNI is useful in predicting long-term outcomes of elderly patients surgically treated for GC, helping to identify those at high risk of death from other disease. In an effort to improve patient outcomes, nutritional status and oncologic staging merit attention.

  4. Nutritional Recovery after Open and Laparoscopic Distal Gastrectomy for Early Gastric Cancer: A Prospective Multicenter Comparative Trial (CCOG1204).

    Science.gov (United States)

    Matsushita, Hidenobu; Tanaka, Chie; Murotani, Kenta; Misawa, Kazunari; Ito, Seiji; Ito, Yuichi; Kanda, Mitsuro; Mochizuki, Yoshinari; Ishigure, Kiyoshi; Yaguchi, Toyohisa; Teramoto, Jin; Nakayama, Hiroshi; Kawase, Yoshihisa; Fujiwara, Michitaka; Kodera, Yasuhiro

    2018-01-01

    Little information from prospective clinical trials is available on the influences of surgical approaches on postoperative body compositions and nutritional status. We designed a prospective non-randomized trial to compare postoperative chronological changes in body composition and nutritional status between laparoscopic and open distal gastrectomy for stage I gastric cancer (GC). Body compositions and nutritional indicators in blood tests were measured at the baseline and at the 1st, 3rd, 6th, and 12th postoperative months (POM). The primary end point was the decrease relative to the baseline in the body muscle mass at POM 6. Ninety-six patients for the laparoscopic group and 52 for the open group were eligible for data analysis. No significant differences were found in any baseline demographics, body compositions, and nutritional indicators between the groups. The changes of body muscle mass at POM 6 were similar in both groups. Overall, no significant differences between the groups were observed in any of the body composition and nutritional indicators during the first year after surgery. Postoperative body compositions and nutritional status were not affected by surgical approaches during the first 12 months after surgery in patients who underwent distal gastrectomy for stage I GC. © 2017 S. Karger AG, Basel.

  5. Feasibility and nutritional impact of laparoscopy-assisted subtotal gastrectomy for early gastric cancer in the upper stomach.

    Science.gov (United States)

    Kosuga, Toshiyuki; Hiki, Naoki; Nunobe, Souya; Noma, Hisashi; Honda, Michitaka; Tanimura, Shinya; Sano, Takeshi; Yamaguchi, Toshiharu

    2014-06-01

    Laparoscopy-assisted total gastrectomy (LATG) is commonly performed for early gastric cancer (EGC) in the upper stomach; however, the incidence of anastomotic complications remains high, and postoperative nutritional status is not satisfactory. This study aimed to evaluate the feasibility and nutritional impact of a novel surgical procedure, laparoscopy-assisted subtotal gastrectomy (LAsTG). This was a retrospective study of 167 patients with EGC in the upper stomach. Of these, 57 patients underwent LAsTG, while 110 patients underwent LATG. Postoperative change in body weight, and serum concentration of albumin (Alb) and total protein (TP) were compared between the LAsTG and LATG groups. Analysis of covariance (ANCOVA) was used to assess the influence of potential confounding factors. Frequency of anastomotic complications was significantly higher in the LATG group (16.3 %) than in the LAsTG group (5.3 %, P = 0.040). Postoperative recovery of body weight at 12 months after surgery was significantly better in the LAsTG group (89.8 ± 1.4 %) than in the LATG group (82.1 ± 1.0 %, P nutritional status.

  6. [Rare indication of cephalic duodenopancreatectomy with total gastrectomy--periampullary carcinoma in moderate form of familial adenomatous polyposis].

    Science.gov (United States)

    Stănciulea, Oana; Preda, Carmen; Herlea, V; Popa, Monica; Ulmeanu, D; Vasilescu, C

    2007-01-01

    We present the case of a 52 years old man, with significant familial history, diagnosed with familial adenomatous polyposis-attenuated form, with no clinical and endoscopic surveillance until 2001 when he was admitted for an upper gastrointestinal haemorrhage episode. Upper gastrointestinal scopy revealed duodenal adenomatous polyps and gastric hyperplastic polyps. The patient underwent duodenopancreatectomy with total gastrectomy. The histopathological exam revealed duodenal G2 adenocarcinoma pT3N0, and gastric hyperplastic polyps with no signs of dysplasia. The surgical procedure was followed by chemotherapy. In 2002 the patient was admitted for rectal bleeding and colonoscopy showed 2 sigmoid polyps, appropriate for endoscopic removal and a poly-lobate polyp in the transverse colon. The patient underwent transverse colectomy (the histopathological exam--in situ carcinoma). March 2003--the patient underwent endoscopic removal for a rectal polyp (histopathological exam: moderate dysplasia). In 2005 was noted a pulmonary nodule, located in the postero-apical segment of upper left lobe, for which left superior lobe resection was performed (the histopathological exam: metastatic adenocarcinoma). In May 2006 was performed an exploratory laparotomy. Intraoperatively were noted: peritoneal carcinomatosis and multiple liver metastasis. The surgical procedure recommended in patients with attenuated form of familial adenomatous polyposis and suspect periampullary lesions is duodenopancreatectomy. The particularity of the case is the association of total gastrectomy for gastric hyperplastic polyps.

  7. The usefulness of levin tube inserted drip infusion spiral CT: comparison with conventional method in subtotal gastrectomy patients

    International Nuclear Information System (INIS)

    Park, Young Jin; Kim, Young Hwan; Yoon, Jung Hee; Cha, Soon Joo; Kim, Jeong Sook; Kim, Sung Rok; Hur, Gham; Rhim, Hyun Chul

    1998-01-01

    The purpose of this study is to access the usefulness of newly designed Levin tube inserted drip infusion spiral CT for the evaluation of remnant stomach and anastomosis site in patients who have undergone subtotal gastrectomy for stomach cancer. A new technique named Levin tube inserted drip infusion spiral CT was used to prospectively study 23 patients. A 16Fr Levin tube was inserted into the remnant stomach; 500 ml of tap water was drip infused just before CT scanning and an additional 500 ml of water was infused during IV contrast injection. Water was infused by gravity, using a water bottle suspended at a height of 90 cm (Group A). The 31 patients who underwent conventional spiral CT scanning immediately after the divided ingestion of 900 ml diluted gastrografin were selected as a control group (Group B). The anatomic delineation of the anastomosis site was graded by two radiologists as excellent (3), good(2), fair (1) or poor (0). To evaluate the degree of distension, the maximal diameters of remnant stomach and the anastomosis site, and the thickness of the stomach wall, were also measured. In patients who had undergone subtobal gastrectomy, Levin tube inserted drip infusion spiral CT showed excellent anatomic delineation of the site of anastomosis and remnant stomach. We found that because it increases the distension of remnant stomach and the anastomosis site, this technique is effective for the evaluation of postoperative stomach. (author). 10 refs., 2 tabs., 3 figs

  8. Laparoscopic atypical gastrectomy in the treatment of gastric GIST. Short-term and medium-term outcomes

    Directory of Open Access Journals (Sweden)

    Santiago Reimondez

    2017-08-01

    Full Text Available Gastrointestinal stromal tumors are the most common mesenchymal neoplasms of the gastrointestinal tract. Recently, many studies have addressed the laparoscopic management of these tumors. The aim of this study was to evaluate the safety and efficacy of laparoscopic atypical gastrectomy in the resolution of these neoplasms. In the period between January 2009 and December 2015, 24 patients with suspected gastric GIST less than 5 cm in size underwent surgery under this approach. Abscense of peritoneal and liver metastases and immunohistochemistry expression of CD117 antigen were considered as inclusion criteria. We retrospectively analyzed clinical and histopathological characteristics, surgical outcomes, postoperative complications and oncological results. Statistical analysis included 14 patients. The mean age was 60 years (10 women and 4 men and upper gastrointestinal bleeding was the chief complaint for consultation. Conversion to open surgery was necessary in one case and no major complications, readmissions or reoperations were recorded. The mean tumor size was 41 mm with negative resection margin in all samples. The mean hospital stay was 3 days and no tumor recurrences were recorded in 44 months of follow-up. Laparoscopic atypical gastrectomy for gastric GIST is a safe and effective technique with good outcomes in experienced hands

  9. [Application of lymph node labeling with carbon nanoparticles by preoperative endoscopic subserosal injection in laparoscopic radical gastrectomy].

    Science.gov (United States)

    Hong, Q; Wang, Y; Wang, J J; Hu, C G; Fang, Y J; Fan, X X; Liu, T; Tong, Q

    2017-01-10

    Objective: To evaluate the application value of carbon lymph node tracing technique by preoperative endoscopic subserosal injection in laparoscopic radical gastrectomy. Methods: From June 2013 to February 2015, seventy eight patients with gastric cancer were enrolled and randomly divided into trial group and control group. Subserosal injection of carbon nanoparticles around the tumor was performed by preoperative endoscopic subserosal injection one day before the operation in trial group, while the patients routinely underwent laparoscopic gastrectomy in control group. Results of harvested lymph nodes, postoperative complications were compared between the two groups. Carbon nanoparticle-related side effect was also evaluated. Results: The average number of harvested lymph node in trial group was significantly higher than that in control group (35.5±8.5 vs 29.5±6.5, P 0.05), and no carbon nanoparticle-related side effect was observed. Conclusion: Given a higher harvested lymph node number and a similar rate of complications, preoperative endoscopic subserosal injection of carbon nanoparticles was safe and feasible.

  10. Ultrasonic dissection versus conventional electrocautery during gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Sun, Z C; Xu, W G; Xiao, X M; Yu, W H; Xu, D M; Xu, H M; Gao, H L; Wang, R X

    2015-04-01

    Use of ultrasonic surgical instrument is gaining popularity for dissection and coagulation in open surgery. However, there is still no consensus on the efficacy and safety of its use compared with conventional surgical technique in open gastrectomy for gastric cancer. The aim of this meta-analysis was to evaluate the role and surgical outcomes of ultrasonic dissection (UD) compared with conventional electrocautery (EC). A systematic literature search was performed to identify all studies comparing UD and EC in gastric cancer surgery. Intraoperative and postoperative outcomes were compared using weighted mean differences (WMDs) and odds ratios (ORs). Five studies were included in this meta-analysis, comprising 489 patients. Meta-analysis results showed that compared with EC, UD was associated with significantly shorter operation time (P = 0.03), less intraoperative blood loss (P = 0.002), lower morbidity (P = 0.02), and reduced postoperative hospital stay (P = 0.03). However, there was no significant difference between the two surgical techniques with regards to postoperative abdominal drainage (P = 0.17), and total cost in hospital (P = 0.59). Compared to EC, the use of UD during open gastrectomy can provide several improved outcomes for operation time, intraoperative blood loss, overall morbidity, and postoperative hospital stay. It appears that UD can be used instead of conventional EC in open gastric cancer surgery, although more larger trials with long follow-up should be performed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Relationship between changes in hemoglobin glycosilated and improvement of body composition in patients with morbid obesity after tubular laparoscopic gastrectomy.

    Science.gov (United States)

    Gallart-Aragón, Tania; Fernández-Lao, Carolina; Cózar-Ibañez, Antonio; Cantarero-Villanueva, Irene; Cambil-Martín, Jacobo; Jiménez Ríos, José Antonio; Arroyo-Morales, Manuel

    2017-12-29

    The objective of our study is to analyze the possible relationship between changes in glycemic profile and body composition parameters in morbid obesity patients after tubular laparoscopic gastrectomy. A prospective observational cohort study with 69 patients was performed. The variables analyzed were body weight, blood glucose, hemoglobin, glycosylated, high density lipoprotein, low density lipoprotein, triglycerides, and waist and hip circumference. An analysis of variance of repeated measurements (ANOVA) and a correlation analysis through the Pearson test were carried out. A significant reduction in weight (p<.001 after surgery) and in glycosylated hemoglobin (p<.036) and waist hip (p<.001) were found at 6 months after surgery. There was no significant difference in the rest of the variables studied. In correlation analysis, a significant positive correlation was found between the change in concentration of hemoglobin glycosylated and hip circumference (p=.047; r=0.237), the smaller the hip circumference, the lower the concentration of glycosylated hemoglobin. Tubular laparoscopic gastrectomy is an effective technique for the treatment of morbidly obese patients with type 2 diabetes mellitus. The reduction in the perimeter of hip is related to glycosylated hemoglobin reduction 6 months after intervention. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  12. A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy

    NARCIS (Netherlands)

    Bergman, J. J.; van Berkel, A. M.; Bruno, M. J.; Fockens, P.; Rauws, E. A.; Tijssen, J. G.; Tytgat, G. N.; Huibregtse, K.

    2001-01-01

    BACKGROUND: A prior Billroth II gastrectomy renders endoscopic sphincterotomy (EST) more difficult in patients with bile duct stones. Endoscopic balloon dilation (EBD) is a relatively easy procedure that potentially reduces the risk of bleeding and perforation. METHODS: Thirty-four patients with

  13. Meta-analysis of the risk of gastric stump cancer: detection of high risk patient subsets for stomach cancer after remote partial gastrectomy for benign conditions

    NARCIS (Netherlands)

    Tersmette, A. C.; Offerhaus, G. J.; Tersmette, K. W.; Giardiello, F. M.; Moore, G. W.; Tytgat, G. N.; Vandenbroucke, J. P.

    1990-01-01

    Controversy about gastric cancer risk after partial gastrectomy exists, especially in the United States. Therefore, we performed a meta-analysis to determine overall relative risk and weighted mean relative risk for subsets of postgastrectomy patients, define possible high risk patients suitable for

  14. Decreased length of stay and earlier oral feeding associated with standardized postoperative clinical care for total gastrectomies at a cancer center.

    Science.gov (United States)

    Selby, Luke V; Rifkin, Marissa B; Yoon, Sam S; Ariyan, Charlotte E; Strong, Vivian E

    2016-09-01

    Standardization of postoperative care has been shown to decrease postoperative length of stay. In June 2009, we standardized postoperative care for all gastrectomies at our institution. Four years' worth of total gastrectomies (2 years prior to standardization and 2 years after standardization) were reviewed to determine the effect of standardization on postoperative care, length of stay, complications, and readmissions. Between June 2007 and July 2011, 99 patients underwent curative intent open total gastrectomy: 51 patients prior to standardization, and 48 patients poststandardization. Patients were predominantly male (70%); median age was 63; and median body mass index was 26. Standardization of postoperative care was associated with a decrease in median time to beginning both clear liquids and a postgastrectomy diet, earlier removal of epidural catheters, earlier use of oral pain medication, less time receiving intravenous fluids, and decreased length of stay (all P Care Center, or readmission. Institution of standardized postoperative orders for total gastrectomy was associated with a significantly decreased length of stay and earlier oral feeding without increasing postoperative complications, early postoperative outpatient visits, or readmissions. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. A new surgical technique of intra-scleral tube fixation in Ahmed Glaucoma Valve implantation: ‘Scleral Sleeve Method’

    Directory of Open Access Journals (Sweden)

    Charudutt Kalamkar

    2017-10-01

    Full Text Available Purpose: To present a new surgical technique ‘Scleral Sleeve Method’ which would reduce the risk of Ahmed Glaucoma Valve (AGV tube related complications in patients undergoing AGV FP7 (New World Medical Inc., Rancho Cucamonga, CA for refractory glaucoma. Design: Prospective, Non-Randomized, hospital based interventional case series. Subjects: A total of 16 eyes of adult patients (10 males and 6 females with refractory glaucoma. Methods: Instead of using sutures to fix the AGV tube to sclera, we devised a novel method of intra-scleral tube fixation by creating a scleral tunnel fashioned in form of sleeve. Main outcome measure: Post-operative tube related complications. Result: There were no tube related complications such as exposure, extrusion or retraction in any of the cases. Conclusion: Use of scleral sleeve method for tube fixation, along with graft to cover the tube, will provide additional safety measure and reduce the risks of tube related complications. Keywords: Ahmed Glaucoma Valve, Scleral Sleeve Method, Intra-scleral tube fixation

  16. Evaluation of an inductively-coupled plasma with an extended-sleeve torch as an atomization cell for laser-excited fluorescence spectrometry.

    Science.gov (United States)

    Kosinski, M A; Uchida, H; Winefordner, J D

    1983-05-01

    An inductively-coupled plasma (ICP) with an extended-sleeve torch has been evaluated as an atomization cell for laser-excited fluorescence spectrometry. Limits of detection for 20 lines are given. The detection power is almost equivalent to that obtained by excitation with a hollow-cathode lamp. Interelement effects and spectral interferences are discussed.

  17. Bronchus anastomosis after sleeve resection for lung cancer: does the suture technique have an impact on postoperative complication rate?

    Science.gov (United States)

    Palade, Emanuel; Holdt, Holger; Passlick, Bernward

    2015-06-01

    Bronchoplastic resections emerged as an alternative to pneumonectomy for patients with impaired pulmonary function and have gained popularity due to a marked decrease in morbidity and at least similar oncological outcome. Actual guidelines recommend sleeve resections whenever technically feasible, even in cases with adequate pulmonary reserve for pneumonectomy, in order to maximally preserve functional lung parenchyma. Various suture techniques were described; the existing evidence, however, is insufficient to recommend one of them as standard. The aim of this study was to compare two suture techniques for bronchus repair after sleeve resection. Two groups of patients from two separate institutions were retrospectively analysed. In Group A (n = 20), the anastomosis was performed with a running suture at the membranous part and an interrupted suture for the rest of the circumference. In Group B (n = 40), a telescoping continuous suture was used. Intra- and postoperative findings directly related to the anastomosis were compared. The parameters were assessed as absolute numbers and percentages; the statistical significance was determined using Pearson's χ(2) test for categorical variables and Student's t-test for continuous data (P resection type (predominance of the right upper lobe for Group B), the groups were comparable regarding patient characteristics. The intraoperative anastomotic assessment revealed: patency 100% in both groups, initial air tightness (100 vs 82.5%; P = 0.047) and buttressing 85 vs 5%. No suture revision was necessary in both groups. The analysis of anastomosis-related morbidity revealed no significant difference: atelectasis (1 in Group A and 2 in Group B; P = 1), reversible anastomotic changes (0 vs 2; P = 0.309), early stenosis (0 vs 0), bronchopleural fistula (1 vs 0; P = 0.154), bronchovascular fistula (0 vs 0), late stenosis (1 vs 0; P = 0.119) and reoperations (15 vs 5%; P = 0.186). The operative mortality rate was similar (2 vs 3; P

  18. The hierarchically organized splitting of chromosome bands into sub-bands analyzed by multicolor banding (MCB).

    Science.gov (United States)

    Lehrer, H; Weise, A; Michel, S; Starke, H; Mrasek, K; Heller, A; Kuechler, A; Claussen, U; Liehr, T

    2004-01-01

    To clarify the nature of chromosome sub-bands in more detail, the multicolor banding (MCB) probe-set for chromosome 5 was hybridized to normal metaphase spreads of GTG band levels at approximately 850, approximately 550, approximately 400 and approximately 300. It could be observed that as the chromosomes became shorter, more of the initial 39 MCB pseudo-colors disappeared, ending with 18 MCB pseudo-colored bands at the approximately 300-band level. The hierarchically organized splitting of bands into sub-bands was analyzed by comparing the disappearance or appearance of pseudo-color bands of the four different band levels. The regions to split first are telomere-near, centromere-near and in 5q23-->q31, followed by 5p15, 5p14, and all GTG dark bands in 5q apart from 5q12 and 5q32 and finalized by sub-band building in 5p15.2, 5q21.2-->q21.3, 5q23.1 and 5q34. The direction of band splitting towards the centromere or the telomere could be assigned to each band separately. Pseudo-colors assigned to GTG-light bands were resistant to band splitting. These observations are in concordance with the recently proposed concept of chromosome region-specific protein swelling. Copyright 2003 S. Karger AG, Basel

  19. Short-term outcomes and nutritional status after laparoscopic subtotal gastrectomy with a very small remnant stomach for cStage I proximal gastric carcinoma.

    Science.gov (United States)

    Furukawa, Haruna; Kurokawa, Yukinori; Takiguchi, Shuji; Tanaka, Koji; Miyazaki, Yasuhiro; Makino, Tomoki; Takahashi, Tsuyoshi; Yamasaki, Makoto; Nakajima, Kiyokazu; Mori, Masaki; Doki, Yuichiro

    2018-05-01

    Total or proximal gastrectomy is usually performed for early proximal gastric carcinoma, but the optimal type of gastrectomy is still unknown. We evaluated short-term outcomes and nutritional status after laparoscopic subtotal gastrectomy (LsTG) in comparison with laparoscopic total gastrectomy (LTG) and laparoscopic proximal gastrectomy (LPG). We analyzed 113 patients who underwent LsTG (n = 38), LTG (n = 48), or LPG (n = 27) for cStage I gastric cancer located in the upper third of the stomach. Postoperative morbidities, nutritional status including body weight, serum albumin, hemoglobin, the prognostic nutritional index (PNI), and endoscopic findings at 1 year after surgery were compared between LsTG and both LTG and LPG. Operation time and intraoperative blood loss were similar among the three groups. The incidence of postoperative morbidities was lower in LsTG than in LTG. The degree of body weight loss was significantly smaller in LsTG than in LTG at 6 and 12 months. At 12 months, LsTG resulted in better serum albumin and PNI than LPG, and better hemoglobin than LTG. Endoscopic examination demonstrated that one LsTG patient and two LPG patients had reflux esophagitis. Remnant gastritis was observed more frequently in LPG than in LsTG. No LsTG patient had bile reflux, although it was observed in four LPG patients. LsTG with a very small remnant stomach had favorable short-term outcomes and nutritional status compared with LTG and LPG, so it may be a better treatment option for cStage I proximal gastric carcinoma.

  20. The behaviour of CAGR moderator and sleeve graphites radiolytically oxidised to high weight loss in inhibited coolant gas compositions

    International Nuclear Information System (INIS)

    Schofield, P.; Fitzgerald, B.; Ketchen, J.

    1987-01-01

    Gilsocarbon graphites were irradiated to high weight losses in three different CO 2 based coolants. The experimental data is tested against a model which interprets the gas phase chemistry and pore geometry and allows weight loss and gas flow properties to be calculated. The observed changes of oxidation rate with dose were successfully predicted from the model. An empirical relationship was also derived which was shown to fit data for moderator, sleeve and special pore structure graphites. Changes in graphite permeability and diffusivity were predicted by the model, and also by other simplified, more approximate methods. The model based upon the measured transport pore spectrum was shown to be the best with other methods proving adequate to moderate doses. (author)

  1. Efficient frequency-domain numerical analysis of modified surface plasmon waveguides formed by a metallic sleeve and coaxial rod

    International Nuclear Information System (INIS)

    Tian Jinping; Xue Wenrui

    2012-01-01

    Some types of modified surface plasmonic waveguides formed by nanometric silver rods with triangular and square cross-section and a coaxial silver sleeve are proposed in this paper. The finite-difference frequency-domain method is used to study the propagation properties of the fundamental mode supported by these types of surface plasmonic waveguides